Tendon transfers after peripheral nerve injuries: my preferred techniques

While there is now keen interest in restoring function lost through irreparable nerve injury by performing nerve-to-nerve transfer, for some time to come, tendon transfers will remain the primary reconstructive procedure for paralytic injuries of the upper limb. A career spanning more than 50 years has permitted the author to try many tendon transfers promoted by past and present colleagues for the three common nerve injuries (median, radial and ulnar) affecting hand function and, eventually, to settle upon those which have provided the most predictable and consistent outcomes. This article describes the author’s preferred tendon transfers for high radial and low median and ulnar palsies, providing the rationale behind these choices, operative details supplemented with illustrations, technical tips and advice regarding postoperative rehabilitation.