In brachial plexus reconstruction, the MOST favored nerve donor for restoring elbow flexion (reinnervating musculocutaneous nerve) via nerve transfer in a preganglionic C5–C6 avulsion is:

• A Sural nerve graft from the ipsilateral leg
• B Intercostal nerve (ICN) transfer — typically 2 to 3 intercostal nerves ✓
• C Contralateral C7 root transfer
• D Phrenic nerve transfer to musculocutaneous nerve

Explanation

In preganglionic avulsion (roots pulled from spinal cord), the root itself is useless as a donor. Intercostal nerve (ICN) transfers — typically the 3rd, 4th, and 5th intercostal nerves (motor branches) — are the classical extraplexal donors for restoring elbow flexion via the musculocutaneous nerve. ICN transfers provide both motor and sensory inputs and are harvested without significant donor morbidity. Phrenic nerve transfer is also used for musculocutaneous reinnervation, though there is risk of respiratory compromise. Contralateral C7 transfer is used for reinnervating the median nerve (restoring wrist/finger flexion) and requires a long graft. Sural nerve is a sensory graft, not a motor transfer.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.