{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:47:45Z","timestamp":1782197265942,"version":"3.54.5"},"reference-count":61,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Anatomy"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Nerve transfer surgery may be performed to restore sensorimotor function following peripheral nerve trauma or dysfunction. There is biological plausibility and limited correlative evidence that donor\u2010to\u2010recipient axon count ratios may impact functional outcomes. Collating anatomical studies that report mean axonal count ratios could guide surgical practice. This systematic review aimed to collate anatomical studies reporting mean axonal counts (MAC) of nerve branches used in upper limb nerve transfer surgery, and calculate MAC ratios for donor\u2010to\u2010recipient nerves and pooled MAC ratios between studies. PubMed, OVID MEDLINE, Google Scholar, and Cochrane were screened for cadaveric studies. For included studies, the donor\u2010to\u2010recipient mean axon ratio was calculated for pairs of nerves suitable for transfer, and ratios were calculated between studies. Methodological heterogeneity precluded metaanalysis. The search yielded 299 results. These were screened to include 54 studies. Mean axonal counts were reported for a total of 225 nerves. Donor\u2010to\u2010recipient axonal ratios were calculated, and stratified into most clinically relevant recipient transfer options; that may be used to inform selection of successful donor nerve options. This is the first comprehensive review of mean axonal count ratios. The collated information regarding MAC ratios could support surgeons in selecting the appropriate donor nerves for upper limb nerve transfer surgery.<\/jats:p>","DOI":"10.1002\/ca.70162","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:10:37Z","timestamp":1782195037000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Donor\u2010To\u2010Recipient Mean Axonal Count Ratios of Upper Limb Nerves Used in Nerve Transfer Surgery: A Systematic Review of Histomorphometric Cadaveric Studies"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7043-7732","authenticated-orcid":false,"given":"Samuel James","family":"Ng","sequence":"first","affiliation":[{"name":"School of Medicine, University of St Andrews  St Andrews UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2618-6758","authenticated-orcid":false,"given":"Rosa","family":"Morgan\u2010Young","sequence":"additional","affiliation":[{"name":"School of Medicine University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Laing","sequence":"additional","affiliation":[{"name":"School of Medicine, University of St Andrews  St Andrews UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Molden","sequence":"additional","affiliation":[{"name":"School of Medicine, University of St Andrews  St Andrews UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9785-5408","authenticated-orcid":false,"given":"Suzanne","family":"Thomson","sequence":"additional","affiliation":[{"name":"School of Molecular Biosciences University of Glasgow  Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"issue":"1","key":"e_1_2_8_2_1","doi-asserted-by":"crossref","DOI":"10.1126\/sciadv.aau2956","article-title":"Peripheral Nerve Transfers Change Target Muscle Structure and Function","volume":"5","author":"Bergmeister K. 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B.","year":"2021","journal-title":"Journal of Hand Surgery"},{"issue":"10","key":"e_1_2_8_46_1","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1016\/j.jhsa.2018.07.013","article-title":"Double Motor Nerve Transfer for All Finger Flexion in Cervical Spinal Cord Injury: An Anatomical Study and a Clinical Report","volume":"43","author":"Sananpanich K.","year":"2018","journal-title":"Journal of Hand Surgery"},{"issue":"6","key":"e_1_2_8_47_1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1177\/1753193414551909","article-title":"Anatomical and Histomorphometric Observations on the Transfer of the Anterior Interosseous Nerve to the Deep Branch of the Ulnar Nerve","volume":"40","author":"Schenck T. L.","year":"2015","journal-title":"Journal of Hand Surgery, European Volume"},{"issue":"1","key":"e_1_2_8_48_1","doi-asserted-by":"crossref","first-page":"135e","DOI":"10.1097\/PRS.0000000000000795","article-title":"Optimal Axon Counts for Brachial Plexus Nerve Transfers to Restore Elbow Flexion","volume":"135","author":"Schreiber J. J.","year":"2015","journal-title":"Plastic and Reconstructive Surgery"},{"key":"e_1_2_8_49_1","unstructured":"Stewart J.2016.\u201cMacro\u2010and Microanatomic Description of Nerve Transfers in the Distal Forearm for the Reconstruction of Hand Function [Internet].\u201dPhD Thesis.https:\/\/edoc.ub.unimuenchen.de\/19784\/1\/Stewart_Jessica.pdf."},{"issue":"6","key":"e_1_2_8_50_1","first-page":"789","article-title":"An Anatomical Study of Transfer of the Anterior Interosseous Nerve for the Treatment of Proximal Ulnar Nerve Injuries","volume":"96","author":"Sukegawa K.","year":"2014","journal-title":"Bone & Joint Journal"},{"issue":"1","key":"e_1_2_8_51_1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.jhsa.2015.10.015","article-title":"A Cadaver Study of Median\u2010To\u2010Radial Nerve Transfer for Radial Nerve Injuries","volume":"41","author":"Sukegawa K.","year":"2016","journal-title":"Journal of Hand Surgery"},{"issue":"5","key":"e_1_2_8_52_1","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1080\/02688697.2019.1630549","article-title":"Restoration of Shoulder External Rotation by Means of the Infraspinatus Muscle Reinnervation With a Radial Nerve Branch Transfer","volume":"34","author":"Tavares P. 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