Nerve Transfers

Question 1

Major indications for nerve transfer

Answer 1

Proximal nerve stump not available
Distance to target is prohibitive to recovery

Question 2

The timeline of muscle atrophy must still be respected with nerve transfers except in wich condition?

Answer 2

Sensory nerve transfers and tetraplegia transfers

Question 3

types of nerve
transfers

Answer 3

End-to-end (he called copulation)
End-to-side (he called inoculation)
reverse end-to-side supercharge
Partial nerve transfers of up to 30% Abspaltung

Question 4

Muscles will atrophy if not reinnervated within 12 to 18 months

Answer 4

T

Question 5

The prognosis for sensory recovery likely declines over time

Answer 5

T

Question 6

recovering nerve may
be utilized. In devastating multinerve injuries or cervical spinal cord
injuries

Answer 6

T

Question 7

regeneration
of only 12% to 30% ofthe native axons leads to motor function equivalent to preinjury function

Answer 7

T

Question 8

donor nerves with over 74%
the number ofaxons in the target nerve led to improved outcomes in
cross-facial nerve grafts for facial palsy

Answer 8

T

Question 9

n patients with injury to the musculocutaneous nerve and loss of elbow flexion what are the options?

Answer 9

flexor digitorum superficialis (FDS) branch or a fascicle of flexor carpi ulnaris (FCU) to transfer· to the biceps

Question 10

In case of prevous question why do we prefer to use the ulnar nerve rather than median

Answer 10

Considering that the
biceps is a supinating muscle and that the median nerve controls pronation,

Question 11

initial retraining following intercostal nerve transfers to the biceps,
the patient must learn to inhale to initiate elbow flexion

Answer 11

T

Question 12

, full voluntary control is possible irrespective of breathing
patterns

Answer 12

T

Question 13

The children need special training for cortical reeducation

Answer 13

F Excellent cortical plasticity in children often enables the motor
reeducation of the transferred nerve without learned tricks

Question 14

It may be intuitive to place the repair
distal on the recipient nerve to shorten the distance to the target, but
a repair with excessive tension risks poor outcomes

Answer 14

t

Question 15

The most significant advantage
of ETS is that donor morbidity is minimized

Answer 15

T

Question 16

ETS is useful when donor nerves are scarce نادر

Answer 16

T

Question 17

ETS transfers have been increasingly used to reconstruct
birth-related brachia! plexus injuries

Answer 17

T

Question 18

reverse ETS or supercharge ETS

Answer 18

indicates leaving the
recipient nerve intact and coapting the proximal end of the donor
nerve to the side of the recipient nerve

Question 19

Indications of reversend to side?

Answer 19

a large mixed motor and sensory nerve is injured proximally
partial nerve injuries. For example,
in a partial ulnar injury where electrodiagnostic studies indicate axons
in continuity to muscles, but severely reduced in number

Question 20

both sensory and motor nerves can be utilized to preserve muscle mass.

Answer 20

T

Question 21

Facial muscle has short reinnervation window

Answer 21

F Facial muscle differs from skeletal muscle and is
thought to have a longer reinnervation window, considered to be
up to 12 to 24 months after injury

Question 22

Two of the most integral movements for facial function are
eye closure and smile,

Answer 22

T

Question 23

The most common nerve transfer in the face

Answer 23

Nerve to masseter

Question 24

advantages of the masseteric nerve

Answer 24

■ Robust axonal supply
■ Ability to be transferred without a graft
■ Reliable location
■ Low donor site morbidity

Question 25

Use of the masseteric nerve typically results in less spontaneous and emotional movement,

Answer 25

T

Question 26

n adults who have had smile movement powered by the masseteric nerve, 85% achieve the ability to smile without biting

Answer 26

T

Question 27

smile spontaneity occurring routinely in 59%with the masseteric nerve

Answer 27

T

Question 28

hypoglossal nerve has yielded greater results with respect to resting tone compare with masseteric one

Answer 28

T

Question 29

Differential innervation of separate facial movements candecrease unnatural mass movements or unwanted synkinetic movements.

Answer 29

T

Question 30

The masseteric nerve is located on the deep surface of the masseter muscle at a point 3 cm anterior to the tragus and I cm inferior to the inferior border of the zygomatic arch

Answer 30

T

Question 31

Regardless of facial movement, corneal anesthesia can be reconstructed

Answer 31

T

Question 32

corneal neurotization all patients regained normal sensation

Answer 32

F all patients achieving protective sensation

Question 33

Branches of the trigeminal nerve can be transferred directly or with a nerve graft to reinnervate important sensory distributions of the face

Answer 33

T

Question 34

Option for suprascapular nerve transferee

Answer 34

. Transfer of the spinal accessory Transfer of the rhomboid nerve to suprascapular

Question 35

In the dissection of the spinal accessory nerve, there are anterior and posterior approach wich is better?

Answer 35

The anterior approach combines well with a cervical approach to the brachia! plexus A posterior approach is used to release the suprascapular notch, In larger patients, this dissection can be quite deep and lighted retractors are necessary

Question 36

Options for axillary nerve?

Answer 36

Radial branch to triceps (Somsak) Medial pectoral

Question 37

Originally, the branch to the long head of the triceps was favored

Answer 37

T

Question 38

Others have argued in favor of the medial branch

Answer 38

because it has a longer extramuscular course

Question 39

In axillary nerve repair grafting is better or nerve transfer is better?

Answer 39

A metaanalysis of grafting versus nerve transfer outcomes for isolated axillary injuries showed no significant differences between the two techniques,

Question 40

Option for Musculocutaneous?

Answer 40

Ulnar branch to FCU (Oberlin) Median branch to FDS/FCR Thoracodorsal Medial pectoral

Question 41

single versus double nerve transfer resulted in similar elbow flexion strength and disabilities of arm

Answer 41

T

Question 42

What is the difference between the single and double nerve transfer for musclucutanouse nerve ?

Answer 42

Only significant difference was in grip strength 63% of the contralateral side whereas the single nerve transfer resulted in 43%

Question 43

In the scenario of complete plexus avulsion what are the options

Answer 43

the distal spinal accessory or intercostal nerves can be used with an interposition nerve graft

Question 44

Radial nerve options?

Answer 44

Ulnar branch to FCU Median branch to FDS/FCR musculocutaneous branch to brachialis

Question 45

Elbow extension restored via ulnar nerve (FCU to the medial triceps)

Answer 45

T

Question 46

In the hand

Answer 46

via median donors FCR and FDS, and motor branch to pronator quadratus-transferred to (PIN) and (ECRP)

Question 47

How you can achieve individual finger extension

Answer 47

Nerve transfer to the PIN is the only method of achieving individual finger extension

Question 48

If biceps function is intact, the PIN fascicle to supinator should be excluded to maximize reinnervation of the more critical extensors

Answer 48

T

Question 49

restore radial hand sensation,ist possible?

Answer 49

lateral antebrachial cutaneous nerve (LABC) to radial sensory can be used

Question 50

Options for ulnar nerve ?

Answer 50

Transfer of the median AIN branch of pronator quadratus to the motor branch of the ulnar nerv

Question 51

Option for sensory ulnar nerve ?

Answer 51

the median branch to the third webspace median palmar cutaneous the LABC

Question 52

Comparison of grafting versus motor and sensory transfers in proximal ulnar nerve injuries which are better?

Answer 52

significantly improved functional outcomes: 80% were at least M3 in the nerve transfer while versus 22% with grafting Interestingly, sensory outcomes were not significantly different

Question 53

Median N. options ?

Answer 53

Ulnar branch to FCU Radial branch to ECRB Musculocutaneous branch to the brachialis Ulnar to 3rd lumbrical Ulnar to abductor digiti minimi Radial to EDQ/ECU

Question 54

Before reinnervation, FPL may lengthen why?

Answer 54

due to unopposed EPL pull and become less effective thus interphalangeal extension blocking can be a helpful adjunct during reinnervation

Question 55

The median recurrent motor branch can be restored through

Answer 55

an ulnar motor branch to the third lumbrical, nerve to abductor digiti quinti, or a radialPIN branch to extensor digiti quinti and extensor carpi ulnaris

Question 56

Can we restore the sensation of the median nerve

Answer 56

Transfer of the sensory digital nerve of the 4th webspace end-to-end to the sensory component of the median nerve can be used to restore sensation in the median distribution of the hand (Bertilli)

Question 57

In case of Flail Arm what is the option ?

Answer 57

Intercostal (IC) nerve or nerve to rectus transferred to the musculocutaneous nerve, either directly or with an interposition nerve graft, can be used to restore elbow flexion or elbow extension

Question 58

Hoe many intercostal nerve we can transfere ?

Answer 58

transfer of two to four nerves, although up to seven have been reported anecdotally

Question 59

The risk of iatrogenic pneumothorax in this dissection is 15%

Answer 59

F 9%

Question 60

patients with combined phrenic and intercostal nerve transfers showed no impact on respiratory function compared to phrenic transfer alone

Answer 60

T

Question 61

Distal nerve transfers advantages in Birth-Related Brachia! Plexus Palsy

Answer 61

■ Avoid morbidity ofneuroma dissection ■ Avoid graft donor site morbidity ■ Reduce distance to target muscle (especially advantageous in late presentations)

Question 62

no significant differences in outcomes from grafting CS to suprascapular versus the spinal accessory transfer.

Answer 62

T

Question 63

The spinal accessory to suprascapular nerve transfer wasaccepted early, because the spinal accessory nerve in the field of the standard cervical approach to the plexus

Answer 63

T

Question 64

improved supination with the grafting versus transfer

Answer 64

F improved supination with the transfer versus grafting

Question 65

whereas grafting resulted in greater pronation

Answer 65

T

Question 66

The triple transfer of spinal accessory to suprascapular, Oberlin transfer, and radial to axillary shows improved supination and shoulder external rotation compared to grafting

Answer 66

T

Question 67

Femoral nerve options

Answer 67

anterior branch of the obturator, supplying the gracilis, adductor longus, and adductor brevis, can serve as a donor to the femoral branches to rectus femoris and vastus medialis

Question 68

Loss of protective sensation to the plantar foot is linked to failure of limb salvage

Answer 68

T

Question 69

Sensation can be restored with a saphenous to tibial nerve transfer, but the distance between these nerves requires an interposition graft

Answer 69

T

Question 70

Tibial nerve options?

Answer 70

Branches to the vastus medialis and vastus lateralis can be transferred to the tibial branches of the gastrocnemius

Question 71

Peronial nerve?

Answer 71

The tibial nerve branches to flexor digitorum longus or flexor hallucis longus can be used as donors to the anterior tibialis to restore extension

Question 72

Cortical remapping is essential for successful outcomes in both motor and sensory nerve transfers

Answer 72

T

Question 73

Patients begin working with a therapist who is knowledgeable about motor retraining ideally preoperatively and then beginning at 3 to 4 weeks postoperatively to begin contractions of donor nerve muscles.

Answer 73

t