{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:38:56Z","timestamp":1747150736449,"version":"3.40.5"},"reference-count":10,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Distal nerve transfers to restore elbow flexion have become standard of care in brachial plexus reconstruction. The purpose of this report is to draw attention to intractable co\u2010contraction as a rare but significant adverse event of distal nerve transfers. Here we report of treatment of a disabling co\u2010contraction of the brachialis muscle and wrist\/finger flexors after median to brachialis fascicular transfer in a 61\u2010year\u2010old male patient. The primary injury was an postganglionic lesion of roots C5\/C6 and a preganglionic injury of C7\/C8 with intact root Th1 after a motor bicycle accident. After upper brachial plexus reconstruction (C5\/C6 to suprascapular nerve and superior trunk) active mobility in the shoulder joint (supraspinatus, deltoid) could be restored. However, due to lacking motor recovery of elbow flexion the patient underwent additional median to brachialis nerve transfer. Shortly after, active elbow flexion commenced with rapid recovery to M4 at 9\u2009months postoperatively. However, despite intensive EMG triggered physiotherapy the patient could not dissociate hand from elbow function and was debilitated by this iatrogenic co\u2010contraction. After preoperative ultrasound\u2010guided block resulted in preserved biceps function, the previously transferred median nerve fascicle was reversed. This was done by dissecting the previous nerve transfer of the median nerve fascicle to the brachialis muscle branch and adapting the fascicles to their original nerve. Postoperatively, the patient was followed up for 10\u2009months without a complication and maintained M4 elbow flexion with independent strong finger flexion. Distal nerve transfers are an excellent option to restore function, however, in some patients cognitive limitations may prevent cortical reorganization and lead to disturbing co\u2010contractions.<\/jats:p>","DOI":"10.1002\/micr.31076","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T22:55:24Z","timestamp":1687647324000},"page":"717-721","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nerve transfer reversal to treat co\u2010contraction after anatomic brachial plexus reconstruction and Oberlin transfer: A case report"],"prefix":"10.1002","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1011-3482","authenticated-orcid":false,"given":"Gregor","family":"Laengle","sequence":"first","affiliation":[{"name":"Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery Medical University Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Gohritz","sequence":"additional","affiliation":[{"name":"Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery Medical University Vienna  Vienna Austria"},{"name":"Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery University Hospital Basel  Basel Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Udo","family":"Maierhofer","sequence":"additional","affiliation":[{"name":"Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery Medical University Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnes","family":"Sturma","sequence":"additional","affiliation":[{"name":"Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery Medical University Vienna  Vienna Austria"},{"name":"Bachelor's Degree Program Physiotherapy University of Applied Sciences FH Campus Wien  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Boesendorfer","sequence":"additional","affiliation":[{"name":"Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery Medical University Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemens","family":"Gstoettner","sequence":"additional","affiliation":[{"name":"Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery Medical University Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannes","family":"Platzgummer","sequence":"additional","affiliation":[{"name":"Department of Biomedical Imaging and Image\u2010guided Therapy Medical University of Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oskar","family":"Aszmann","sequence":"additional","affiliation":[{"name":"Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery Medical University Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,6,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22179358"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1523\/jneurosci.13-06-02730.1993"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25018"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/S12593-011-0031-1"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.JHSE.2007.03.004"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/0363-5023(94)90011-6"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.1.112"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.3791\/59840"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2018.00906"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.3171\/JNS.2003.98.2.0313"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.31076","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T07:35:41Z","timestamp":1697528141000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.31076"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,22]]},"references-count":10,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1002\/micr.31076"],"URL":"https:\/\/doi.org\/10.1002\/micr.31076","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"type":"print","value":"0738-1085"},{"type":"electronic","value":"1098-2752"}],"subject":[],"published":{"date-parts":[[2023,6,22]]},"assertion":[{"value":"2022-04-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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