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Transferring radial nerve triceps fascicles to the axillary nerves

Nerve transfer was first described in 1948 by Alexander Lurje using the triceps fascicles of the radial nerve transfer to the axillary nerve in one patient with Erb’s palsy. It wasn’t until recently that the method for surgical treatment of nerve injuries became more widely accepted for brachial plexus injuries.

Today, nerve transfers are an increasingly popular treatment for nerve injuries. One of the most popular methods is the transfer of radial nerve fascicles to the axillary nerve. The most common approach for this transfer is the posterior approach, which gives excellent access to both nerves but is not easy to combine with other nerve transfers.

We describe an alternative, the anterior approach. This new technique offers safe access to both radial and axillary nerves and has the added advantage of compatibility with approaches for other common nerve transfers, such as the Oberlin transfer. Targeting the anterior branch of the axillary nerve maximizes restoration of shoulder abduction.

We successfully performed this technique, combined with two other nerve transfers, on a five-month-old girl with bilateral brachial plexus birth injury. In addition to partial radial nerve to axillary transfer and an Oberlin transfer, the patient also received partial spinal accessory nerve transfer. While complications can arise due to the close proximity of the axillary vessels, to improve visualization, we recommend a slight reverse Trendelenberg position to keep the axillary vein from becoming distended.

Bauer, A, Rabinovich, RV, Waters PM. The Anterior Approach for Transfer of Radial Nerve Triceps Fascicles to the Axillary Nerve. The Journal of Hand Surgery.