A novel nerve transfer: The first palmar interosseous motor branch of the ulnar nerve to the recurrent motor branch of the median nerve

•The recurrent motor branch of the median nerve provides innervation for opposition and pinch.•The recovery of recurrent motor branch of the median nerve might be delayed in high level median nerve injuries.•This novel nerve transfer requires minimal dissection and restores opposition and pinch.•Anatomical proximity of the two nerves, the similar nerve diameter, and similar axon counts provide a convenient nerve transfer technique. The recovery of recurrent motor branch of the median nerve might be delayed in high level median nerve injuries due to the long reinnervation distance. The aim of this study is to define a novel nerve transfer to restore the opposition and pinch. Two fresh frozen hand cadavers were used for the study. The motor branch of the first palmar interosseous muscle of the ulnar nerve was identified and dissected. Thenar branch of the median nerve was dissected from its insertion site. The motor branch of the first palmar interosseous muscle of the ulnar nerve was transferred to the thenar motor branch of the median nerve. Axon counts were examined histopathologically. Clinically this nerve transfer was performed for two female patients with a high-level median nerve injury. Mehta opposition scores were 21 and 20, respectively and the results were satisfactory six months after the surgery. Although exploration and repair are recommended as the first treatment for median nerve injuries, the waiting time until the motor branch is reinnervated is critical in high level lesions. Nerve transfers become very important for fast recovery. This new nerve transfer proposal may be an important step in nerve transfer surgery.