Table 4.
Comparison between Proximal-to-Distal and Distal-to-Proximal Reconstructive Priority
| Proximal to Distal | Distal to Proximal | |
|---|---|---|
| Philosophy | Traditional nerve first,* FFMT next | New strategy; FFMT first, nerve next |
| Reconstruction priority | Shoulder, elbow first, then finger | Fingers and elbow first, then shoulder |
| Brachial plexus exploration | Yes | Possibly no |
| Nerve reconstruction | ||
| For shoulder | Yes | May or may not be required |
| For elbow | Yes | Need FFMT |
| For finger | Yes | Need FFMT |
| Stage requirement | May be one stage | Multiple stages |
| Rehabilitation period | Longer (at least 4 years) | Usually 2 years |
| Patient selection | Highly motivated, intelligent, and compliant | Low compliance, impatient patient |
| Outcome prediction | ||
| Shoulder elevation | Better (≥60 degrees) | Shoulder fusion (10 to 30 degrees) |
| Elbow flexion | Usually better (M4) | M3–4 |
| Finger flexion | M2–4 | M2–3 |
| Finger extension (EDC) | M0 | M2–3 |
*
Nerve first: nerve reconstruction first.