Table 4.
Specific Nerve Transfer Options for Each of the Various Partial Hand Amputation Subtypes
| Partial Hand Amputation Subtype | Nerve Transfer Options | ||
|---|---|---|---|
| Ulnar Nerve | Median Nerve | Radial Sensory Nerve | |
| Ray amputation | Utilize motor nerve target of residual muscles adjacent to resected ray: | ||
| • Volar interosseus muscle | |||
| • Dorsal interosseus muscle | |||
| • Lumbrical | |||
| Radial hand amputation: Transfer sensory nerve stumps to ulnar hand (away from prosthesis docking site) | N/A | Volar interossei 2/3 Dorsal interossei 3/4 Lumbricals 4/5 | Dorsal interossei 3/4 AIN to PQ |
| Ulnar hand amputation: Transfer sensory nerve stumps to radial hand (away from prosthesis docking site) | Volar interossei 1/2 Dorsal interossei 1/2 Lumbricals 2/3 | N/A | N/A |
| Trans-metacarpal ± thumb amputation | Volar interossei 2/3 Dorsal interossei 3/4 Lumbricals 4/5 | Volar interossei 1/2 Dorsal interossei 1/2 Lumbricals 2/3 | 1st dorsal interosseus thenar motor branch AIN to PQ |
| Trans-carpal amputation | Volar interossei 2/3 Dorsal interossei 3/4 Lumbricals 4/5 FCU AIN to PQ | Volar interossei 1/2 Dorsal interossei 1/2 Lumbricals 2/3 Thenar motor branch AIN to PQ | 1st dorsal interosseus thenar motor branch AIN to PQ |
| Starfish procedure** | Interossei dissected out, pedicled on the palmar neurovascular arch, and transposed to the dorsal hand | ||
**From Gaston et al.13