Management of Isolated Musculocutaneous Injury: Comparing Double Fascicular Nerve Transfer With Conventional Nerve Grafting

Purpose To compare the functional outcomes of nerve grafts and nerve transfers in the management of isolated musculocutaneous nerve (MCN) injuries. Methods We performed a retrospective case-control study of isolated MCN injury managed at a tertiary care center. The study group was composed of 12 patients managed with double nerve transfer whereas the 8 patients in the grafted group constituted the control group. Results In the study group, stab and missile injuries constituted most cases with a denervation period ranging between 3 and 9 months. Eleven patients in this group experienced a full range of active elbow flexion whereas one had antigravity flexion of 120 degrees. Electromyography revealed the first sign of reinnervation of biceps at 10 +/- 2 weeks, compared with 20 +/- 2 weeks in the grafted group. The overall trend was for patients in the study group to have earlier return of active elbow flexion and better restoration of elbow flexion strength and range of (presumably active) elbow motion than those treated with grafting, although none of these measures reached statistical significance. Conclusions We found that distal nerve transfer was a superior method of managing isolated MCN injury compared with conventional nerve grafting. (J Hand Surg Am. 2015;40(10):2003-2006. Copyright (C) 2015 by the American Society for Surgery of the Hand. All rights reserved.)