Table 3.

“Recipes” for high-level nerve injuries as alternatives to sural graft

Nerve injury	Priorities	Reconstruction technique
Median	AIN function Thumb opposition Pronation Sensation	Motor nerve transfersa  - ECRB to PT  - Brachialis or supinator to AIN Sensory transfers  - DCU to thumb and radial index sensory fascicles ETE  - TWM and distal DCU to ulnar sensory fascicles ETS Tendon transfers  - Opponensplasty
Radial	Wrist, finger, and thumb extension Sensation	Motor nerve transfers  - FDS to ECRB  - FCR to PIN Sensory transfers  - LABC to SBR ETE  - SBR to median ETS Tendon transfers  - PT to ECRB for early wrist extension (optional)
Ulnar	Intrinsic function Ring and small finger flexion Sensation	Motor nerve transfers  - AIN to ulnar motor Sensory transfers  - TWM to ulnar sensory fascicles ETE  - PCM to DCU ETE or DCU to median ETS Tendon transfers  - Tenodesis of FDP tendons

Used with permission from Mackinnon SE, ed. Nerve Surgery. New York, NY: Thieme; 2015

AIN anterior interosseous nerve, ETE end-to-end, ETS end-to-side, DCU dorsal cutaneous branch of ulnar nerve, PCM palmar cutaneous branch of median, SBR radial sensory nerve, TWM third webspace branch of median nerve

^aAll motor transfers are end-to-end