Fundamental Principles

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The recipient nerve should be repaired as close as possible to the target muscle to ensure the shortest amount of time for re-innervation in an attempt to minimize distal denervation and motor end plate changes.
Donor nerve should be from a muscle whose function is expendable or has redundant innervation.
Nerve repair should be performed directly without intervening grafts.
Use of a donor muscle with pure motor fibers maximizes muscle fiber re-innervation.
Donor nerve should have a large number of motor axons and be a reasonable size match to the recipient nerve.
To facilitate motor re-education, a donor nerve that has a function synergistic to the muscle reconstructed should be used because cortical re-adaptation is the physiological basis of functional recovery.
Motor re-education improves functional recovery post operatively.