77th ASSH Annual Meeting - Back to Basics: Practice and Education-IC06: Why Didn't My Nerve Transfer Work? And Now What Do I Do? (AM22)

Video Transcription

Video Summary

Dr. Alex Shin discusses the factors that can lead to a nerve transfer for elbow flexion failing, emphasizing the importance of careful decision making and surgical technique. He notes that using injured nerves for transfers can decrease success rates and that accurately measuring outcomes can be challenging. Dr. Shin recommends considering alternative treatment options, such as amputation and myoelectric fitting, or using free muscle transfers with available donor nerves when nerve transfers fail. He urges surgeons to think creatively and consider all possibilities for patients who have failed nerve transfers. However, he also acknowledges that in some cases, there may be no further treatment options available and surgeons should be honest with their patients about this. Dr. Shin concludes by recommending a chapter by Amy Moore on outcomes and treatment options for failed nerve transfers as a valuable resource for surgeons.<br /><br />The video transcript focuses on ulnar nerve transfers for intrinsic function. The speaker highlights the importance of patient selection and timing for optimal outcomes. Different techniques, such as the AIN to ulnar motor nerve transfer and the transfer of the opponent's pollicis branch of the median nerve, are discussed. The speaker emphasizes the technical aspects of these operations, including tension-free coaptation. Nerve transfers are shown to have better outcomes compared to nerve grafting alone. If nerve transfers fail, salvage options like tendon transfers may be considered. The speaker underscores the significance of post-operative rehabilitation and the use of surface EMG biofeedback to aid in muscle activation. Overall, successful outcomes depend on patient selection, skilled surgery, and appropriate rehabilitation.

Meta Tag

Session Tracks Microsurgery

Session Tracks Nerve

Session Tracks Shoulder/Elbow

Session Tracks Tendon

Speaker Alexander Y. Shin, MD

Speaker Bryan J. Loeffler, MD

Speaker Christopher J. Dy, MD, MPH, FACS

Speaker David M. Brogan, MD, MSc.

Speaker Hollie Power, MD

Speaker Jayme A. Bertelli, MD, PhD

Keywords

nerve transfer

elbow flexion

careful decision making

surgical technique

alternative treatment options

failed nerve transfers

ulnar nerve transfers

patient selection

tendon transfers

rehabilitation

successful outcomes