Fundamental Principles

  1. 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.
  2. Donor nerve should be from a muscle whose function is expendable or has redundant innervation.
  3. Nerve repair should be performed directly without intervening grafts.
  4. Use of a donor muscle with pure motor fibers maximizes muscle fiber re-innervation.
  5. Donor nerve should have a large number of motor axons and be a reasonable size match to the recipient nerve.
  6. 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.
  7. Motor re-education improves functional recovery post operatively.