In the past century, significant understanding in the field of peripheral nerve surgery has been made with the increasing advances of microsurgical techniques and knowledge of topography of peripheral nerves as well as the cellular and molecular events. As our understanding of nerve injury and repair increases, new techniques of nerve repair including nerve autograft, nerve allograft, tendon transfers and nerve transfers have been performed in the clinic. Although autografting is still the gold

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... standard of nerve repair when possible, nerve transfers have gained great popularity among surgeons especially in the distal forearm for wrist and hand functional reconstruction. The most frequently distal nerve transfer is the transfer of the AIN to the DBUN for intrinsic hand reconstruction. Specific successful nerve transfer of the AIN to the DBUN has stimulated us to transfer the AIN to the TBMN to reconstruct the thenar muscle function and transfer the DBCUN to the SBRN or the SMN for sensory reconstruction. As previously reported, the AIN can be sacrificed because the loss of pronation function in the forearm can be compensated by the pronator teres muscle and the DCBUN can be cut because the medial dorsal side of the hand is a non-critical area. This feature of the AIN and the DCBUN allows us to use them as donor nerves which meet the technical point of nerve transfer in the upper extremity 'donor distal, recipient proximal'. Therefore we cut the AIN at the proximal border of the pronator quadratus muscle and the DCBUN before the first bifurcation in order to maximize the axon number and decrease the regeneration distance. For the recipient nerve, we transected the SMN and the TBMN proximally enough so that they can be mobilized to allow a tension-free coaptation. Moreover, divided proximally can avoid necessity for nerve grafting as well as axon misdirection, which could substantially downgrade the functional recovery. There are two sides for everything and that certainly is time for nerve transfers as well. The ma [...]