Distal nerve transfers for median nerve reinnervation and hand function restoration.

Introduction: Proximal and extensive median nerve median nerve injuries cause profound disability, impairing daily activities and quality of life. Outcomes after autologous nerve grafting are often suboptimal, due to long regeneration distances and complex branching. Distal nerve transfers offer a more direct reconstructive approach. Research question: May combined distal nerve transfers (ECRB-AIN, SUP-FDS, ADM-TE, and DDN-PDN) restore hand function and quality of life in patients with proximal or extensive median nerve injuries? Material and methods: A retrospective series of 13 patients (9 males, 4 females; mean age 35 years (17-62)) who underwent distal nerve transfer procedure(s) between 2011 and 2022 for proximal or extensive median nerve injury. All patients were followed for at least 2 years with standardized pre- and postoperative assessment of motor function, grasp and pinch strength, thumb opposition (Kapandji score), and quality of life (PNSQoL). Results: All patients initially presented with absent finger flexion (M0), of which: 11 achieved M4 recovery, while one reached M2 and M1. Grasp strength improved from 22.8% (0-45%) to 62.8% (13-87%), pinch strength from 27.5% (0-43%) to 62.0% (20-90%), Kapandji score from 4.2 (1-6) to 7.5 (2-10), and PNSQoL from 41.3 (30-47) to 67.4 (45-79). All improvements were statistically significant (p < 0.01). Discussion and conclusion: Distal nerve transfers provided consistent functional recovery, supporting their role as a primary reconstructive strategy in proximal median nerve injuries. Combined motor and sensory transfers yielded meaningful improvements in grasp, pinch, thumb opposition, and quality of life.