Optimizing Intercostal Nerve Transfers for Brachial Plexus Reconstruction | Dr. Daniel Gould

Dr. Daniel Gould co-authored this systematic review published in HAND, examining the optimal number of intercostal nerve transfers needed to restore elbow flexion following traumatic brachial plexus injuries.

Brachial plexus injuries can cause significant loss of movement and strength in the upper extremity. When conventional nerve repair is not possible, intercostal nerves from the chest may be transferred to the musculocutaneous nerve to help restore function, particularly elbow flexion.

The researchers systematically reviewed 12 studies involving 196 patients who received two, three, or four intercostal nerve transfers. They compared postoperative muscle strength to determine whether transferring additional nerves resulted in better functional recovery.

The analysis found no significant difference in elbow flexion strength based on whether two, three, or four intercostal nerves were transferred. Because harvesting additional intercostal nerves can increase donor-site morbidity, the authors recommended using two nerves when transferring intercostal nerves to the musculocutaneous nerve. 

The study contributes to the refinement of peripheral nerve reconstruction by demonstrating how surgical planning can balance functional recovery with minimizing unnecessary donor-site morbidity.