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Deformities of the spastic upper limb result frequently from the association of spasticity, muscle contracture and muscle imbalance between strong spastic muscles and weak non-spastic muscles. This study was designed to evaluate the feasibility of combining selective neurectomy of the usual spastic and strong muscles together with transfer of their motor nerves to the usual weak muscles, to improve wrist and fingers motion while decreasing spasticity.Twenty upper limbs from fresh frozen human cadavers were dissected. All motor branches of the radial and median nerve for the forearm muscles were identified. We attempted all possible end-to-end nerve transfers between the usually strong "donor" motor branches, namely FCR and PT, and the usually weak "recipient" motor branches (ERCL, ECRB, PIN, AIN). The PT had two nerve branches in 80%, thus allowing selective neurectomy. The proximal PT branch could be anastomosed end-to-end in 45% (AIN) to 85% (ECRL) of cases with the potential recipient branches. The distal PT branch could be anastomosed end to end to all potential recipient nerves. The FCR had a single branch in all cases. End-to-end anastomosis was possible in 90% for the ECRL and in 100% for all other recipient branches, but sacrificed all FCR innervation, ruling out hyperselective neurectomy. Selective neurectomies can be associated with distal nerve transfers at the forearm level in selected cases. The motor nerve to the PT is the best donor for nerve transfer combined with selective neurectomy, transferred to the ECRL, ECRB, PIN or AIN.

Supplemental material, sj-pdf-2-jhs-10.1177_17531934211027499 for Hyperselective neurectomy for the treatment of upper limb spasticity in adults and children: a prospective study by Caroline Leclercq, Anne Perruisseau-Carrier, Mathilde Gras, Paolo Panciera, Camillo Fulchignoni and Marcello Fulchignoni in Journal of Hand Surgery (European Volume)

Supplemental material, sj-pdf-1-jhs-10.1177_17531934211027499 for Hyperselective neurectomy for the treatment of upper limb spasticity in adults and children: a prospective study by Caroline Leclercq, Anne Perruisseau-Carrier, Mathilde Gras, Paolo Panciera, Camillo Fulchignoni and Marcello Fulchignoni in Journal of Hand Surgery (European Volume)

Objectives/Interrogation: The goal of surgery of the spastic upper limb is to rebalance forces between spastic and contracted muscles on one side, and paralyzed or pseudo-paralyzed antagonists. Surgery for contracted muscle involves various standard techniques of muscle lengthening. The spastic[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)