SCIENTIFIC ARTICLE Distal Nerve Transfers to the Triceps Brachii Muscle: Surgical Technique and Clinical Outcomes Noor Alolabi, MD,* Andrew J. Lovy, MD,* Michelle F. Kircher, BS,* Robert J. Spinner, MD,† Allen T. Bishop, MD,* Alexander Y. Shin, MD* Purpose To report the clinical outcomes and describe the surgical technique of triceps muscle reinnervation using 2 different distal nerve transfers: the flexor carpi ulnaris (FCU) fascicle of the ulnar nerve and the posterior branch of the axillary nerve (PBAN) to the triceps nerve branch. Methods A retrospective review of patients undergoing FCU fascicle of ulnar nerve or PBAN to triceps nerve branch transfer was performed. Outcome measures included preoperative and postoperative modified British Medical Research Council (MRC) score, EMG results, and complications. Results Between September 2003 and April 2017, 6 patients were identified. Four patients with a traumatic upper trunk and posterior cord palsy underwent ulnar nerve fascicle to triceps nerve transfer. Two patients with a recovering upper trunk following a pan-brachial plexus palsy underwent PBAN to triceps nerve branch transfer. The median age was 30.0 years (range, 18e68 years). Surgery was performed at a median of 6.9 months (range, 5.0e8.9 months) postinjury, with a median follow-up of 18.4 months (range, 7.6e176.3) months. Before surgery, 4 patients exhibited grade M0 and 2 patients exhibited grade M1 triceps strength. Four patients had M5 donor muscle strength and 2 had grade M4. Postoperatively, 4 patients regained MRC grade M4 triceps muscle strength, 1 regained M3, and 1 regained M2. There was no noticeable donor muscle weakness. Conclusions Nerve fascicles to the FCU and PBAN are viable options for obtaining meaningful triceps muscle recovery in a select group of patients. (J Hand Surg Am. 2019;-(-):1.e1-e8. Copyright Ó 2019 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Therapeutic V. Key words Nerve transfer, surgical technique, triceps muscle. T HERE IS GENERAL AGREEMENT that the highest reconstructive priorities in brachial plexus injury reconstruction are restoration of elbow flexion and shoulder function. 1 Triceps func- tion reconstruction is generally a lower priority because many patients compensate adequately using gravity when shoulder movement remains below the horizontal plane. Reconstruction becomes critical when hand function is preserved or when From the *Department of Orthopedic Surgery, Division of Hand and Microvascular Surgery; and the †Department of Neurosurgery, Mayo Clinic, Rochester, MN. Received for publication July 2, 2018; accepted in revised form May 3, 2019. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Alexander Y. Shin, MD, Department of Orthopaedic Surgery, Division of Hand and Microvascular Surgery, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905; e-mail: shin.alexander@mayo.edu. 0363-5023/19/---0001$36.00/0 https://doi.org/10.1016/j.jhsa.2019.05.005 Ó 2019 ASSH r Published by Elsevier, Inc. All rights reserved. r 1.e1