Results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerve
Purpose: Contralateral C7 nerve transfer (CC7) surgery has demonstrated success in restoring upper limb motor function after central nervous system injuries. However, deficits in finger extension limit patient independence. This study evaluates a nerve transfer that transfers the motor branch of th...
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Medical Journals Sweden
2025-08-01
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| Series: | Journal of Plastic Surgery and Hand Surgery |
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| Online Access: | https://medicaljournalssweden.se/JPHS/article/view/44128 |
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| author | Sihan Hu Lingkang Zhu Xuanyu Zhao Wanling Zheng Guobao Wang Yundong Shen Yan-Qun Qiu Wendong Xu |
| author_facet | Sihan Hu Lingkang Zhu Xuanyu Zhao Wanling Zheng Guobao Wang Yundong Shen Yan-Qun Qiu Wendong Xu |
| author_sort | Sihan Hu |
| collection | DOAJ |
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Purpose: Contralateral C7 nerve transfer (CC7) surgery has demonstrated success in restoring upper limb motor function after central nervous system injuries. However, deficits in finger extension limit patient independence. This study evaluates a nerve transfer that transfers the motor branch of the flexor carpi radialis (FCR) to the posterior interosseous nerve (PIN) to improve finger extension.
Methods: Two patients with chronic brain injuries, who showed minimal finger extension recovery for over 1 year after CC7 surgery, were enrolled. Both patients then underwent the nerve transfer procedure. Upper extremity motor function was measured using the Fugl-Meyer upper extremity scale (UEFM), and changes in muscle tone were quantified with the Modified Ashworth Scale (MAS). Regular follow-up evaluations were conducted over an 18-month postoperative period to monitor motor recovery and spasticity.
Results: Within the first postoperative month, both patients exhibited significant improvements in spasticity. Although a minor rebound occurred in the second month, spasticity levels stabilized in subsequent evaluations. By 18 months after surgery, one patient regained functional finger extension, underscoring the potential efficacy of the procedure. Importantly, wrist flexion, governed by the flexor carpi radialis, remained unaffected throughout recovery.
Conclusion: FCR-to-PIN nerve transfer alleviates spasticity and partially restores finger extension in patients with limited recovery following contralateral C7 nerve transfer. Although full motor recovery was not achieved, these findings offer promising clinical implications. Overall, the results support the procedure’s value in clinical practice. Further studies with larger cohorts are needed to confirm these results and elucidate underlying mechanisms.
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| format | Article |
| id | doaj-art-ae0cc246fc334a6fac084d14249d4176 |
| institution | Kabale University |
| issn | 2000-6764 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Journal of Plastic Surgery and Hand Surgery |
| spelling | doaj-art-ae0cc246fc334a6fac084d14249d41762025-08-25T11:15:55ZengMedical Journals SwedenJournal of Plastic Surgery and Hand Surgery2000-67642025-08-0160110.2340/jphs.v60.44128Results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerveSihan Hu0Lingkang Zhu1Xuanyu Zhao2Wanling Zheng3Guobao Wang4Yundong Shen5Yan-Qun Qiu6Wendong Xu7National Clinical Research Center for Aging and Medicine, Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, ChinaDepartment of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Fudan University, Shanghai, ChinaDepartment of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Fudan University, Shanghai, ChinaNational Clinical Research Center for Aging and Medicine, Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, ChinaDepartment of Plastic and Cosmetic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, ChinaNational Clinical Research Center for Aging and Medicine, Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Fudan University, Shanghai, ChinaNational Clinical Research Center for Aging and Medicine, Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Fudan University, Shanghai, ChinaNational Clinical Research Center for Aging and Medicine, Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing’an District Central Hospital, Fudan University, Shanghai, China; Institute of Brain Science, State Key Laboratory of Medical Neurobiology and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; Research Unit of Synergistic Reconstruction of Upper and Lower Limbs after Brain Injury, Chinese Academy of Medical Sciences, Shanghai, China Purpose: Contralateral C7 nerve transfer (CC7) surgery has demonstrated success in restoring upper limb motor function after central nervous system injuries. However, deficits in finger extension limit patient independence. This study evaluates a nerve transfer that transfers the motor branch of the flexor carpi radialis (FCR) to the posterior interosseous nerve (PIN) to improve finger extension. Methods: Two patients with chronic brain injuries, who showed minimal finger extension recovery for over 1 year after CC7 surgery, were enrolled. Both patients then underwent the nerve transfer procedure. Upper extremity motor function was measured using the Fugl-Meyer upper extremity scale (UEFM), and changes in muscle tone were quantified with the Modified Ashworth Scale (MAS). Regular follow-up evaluations were conducted over an 18-month postoperative period to monitor motor recovery and spasticity. Results: Within the first postoperative month, both patients exhibited significant improvements in spasticity. Although a minor rebound occurred in the second month, spasticity levels stabilized in subsequent evaluations. By 18 months after surgery, one patient regained functional finger extension, underscoring the potential efficacy of the procedure. Importantly, wrist flexion, governed by the flexor carpi radialis, remained unaffected throughout recovery. Conclusion: FCR-to-PIN nerve transfer alleviates spasticity and partially restores finger extension in patients with limited recovery following contralateral C7 nerve transfer. Although full motor recovery was not achieved, these findings offer promising clinical implications. Overall, the results support the procedure’s value in clinical practice. Further studies with larger cohorts are needed to confirm these results and elucidate underlying mechanisms. https://medicaljournalssweden.se/JPHS/article/view/44128Hemiplegianerve transferreinnervationparalysisstroke |
| spellingShingle | Sihan Hu Lingkang Zhu Xuanyu Zhao Wanling Zheng Guobao Wang Yundong Shen Yan-Qun Qiu Wendong Xu Results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerve Journal of Plastic Surgery and Hand Surgery Hemiplegia nerve transfer reinnervation paralysis stroke |
| title | Results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerve |
| title_full | Results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerve |
| title_fullStr | Results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerve |
| title_full_unstemmed | Results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerve |
| title_short | Results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerve |
| title_sort | results of finger extension reconstruction in hemiplegic patients after stroke by transferring the flexor carpi radialis branch to the posterior interosseous nerve |
| topic | Hemiplegia nerve transfer reinnervation paralysis stroke |
| url | https://medicaljournalssweden.se/JPHS/article/view/44128 |
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