Latest Surgical Technique
Median and/or Ulnar Nerve Fascicle Transfer for the Restoration of Elbow Flexion in Upper Neonatal Brachial Plexus Palsy
by Kevin J. Little, MD; Dan A. Zlotolow, MD; Francisco Soldado, MD; Roger Cornwall, MD; Scott H. Kozin, MD



Transfer of a fascicle of the ulnar and/or median nerve to the musculocutaneous nerve in order to reinnervate the biceps and/or brachialis muscles has a high success rate and a low rate of complications in infants with upper (C5-C6) or extended upper (C5-C7) neonatal brachial plexus palsy.

Step 1: Make the Incision

Make a longitudinal incision along the midline of the middle third of the medial brachium.

Step 2: Mobilize the Musculocutaneous Nerve

The musculocutaneous nerve is typically found on the undersurface of the biceps muscle.

Step 3: Mobilize the Median Nerve

The median nerve runs along the neurovascular sheath medial to the brachial artery.

Step 4: Mobilize the Ulnar Nerve

The ulnar nerve lies posterior to the intermuscular septum.

Step 5: Transfer the Donor Nerve to the Recipient Nerve

Cut the donor fascicles distally and the recipient fascicles proximally to facilitate transfer.

Step 6: Close the Wound

Irrigate the wound, and close it in layers.

Step 7: Postoperative Protocol

Remove the bandages two weeks postoperatively, and encourage passive range-of-motion exercises.


In our series, thirty-one patients underwent single or combined nerve fascicle transfer; twenty-seven (87%) obtained functional elbow flexion recovery (Active Movement Scale [AMS] score ≥ 6) while twenty-four (77%) obtained full elbow flexion recovery (AMS score = 7).
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John H. Wedge, MD, FRCS(C) responds to:

I would like to thank Mr. Cove for pointing out an obvious typographical error in our manuscript. The vessel described is indeed a branch of the lateral, rather than the medial circumflex femoral a