Surgical Procedures

Double Fascicular Transfer: Median Fascicle to Biceps Branch and Ulnar Fascicle to Brachialis Branch Nerve Transfers

The double fascicular transfer (DFT) includes two nerve transfers: (1) median fascicle to biceps branch and (2) ulnar fascicle to brachialis branch. The median fascicle contains nerve fibers that innervate flexor digitorum superficialis / flexor carpi radialis. The ulnar fascicle contains nerve fibers that innervate flexor carpi ulnaris. The donor fascicles can be used for either recipient nerves depending on the length required, but the nerve transfers described above are typically used. The DFT is used to restore elbow flexion when median and ulnar nerves are intact.

Standard 101111

Extended 101111

POSITION

Supine.

INCISION

An incision on the medial aspect of the arm between the interval of the biceps and triceps.

REFERENCES

  1. Liverneaux PA, Diaz LC, Beaulieu JY, Durand S, Oberlin C. Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies. Plast Reconstr Surg. 2006 Mar;117(3):915-9. PMID: 16525285.
  2. Mackinnon SE, Novak CB, Myckatyn TM, Tung TH. Results of reinnervation of the biceps and brachialis muscles with a double fascicular transfer for elbow flexion. J Hand Surg Am. 2005 Sep;30(5):978-85. PMID: 16182054.
  3. Tung TH, Novak CB, Mackinnon SE. Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries. J Neurosurg. 2003 Feb;98(2):313-8. PMID: 12593617.
  4. Oberlin C, Ameur NE, Teboul F, Beaulieu JY, Vacher C. Restoration of elbow flexion in brachial plexus injury by transfer of ulnar nerve fascicles to the nerve to the biceps muscle.Tech Hand Up Extrem Surg. 2002 Jun;6(2):86-90. PMID: 16520622.
  5. Oberlin C, Béal D, Leechavengvongs S, Salon A, Dauge MC, Sarcy JJ. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases. J Hand Surg Am. 1994 Mar;19(2):232-7. PMID: 8201186.
  6. Brandt KE, Mackinnon SE. A technique for maximizing biceps recovery in brachial plexus reconstruction. J Hand Surg Am. 1993 Jul;18(4):726-33. PMID: 8349991.

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.

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