To propose a four-level decision-making framework for distal nerve transfer surgery that addresses the heterogeneity in injury patterns, donor selection, surgical techniques, and outcome measures in the context of peripheral nerve injuries.
Approach:
Framework Development: The framework integrates the authors' extensive surgical experience with current literature, emphasizing the importance of donor feasibility through availability, suitability, and acceptability.
Literature Review: The authors reviewed existing literature to identify reconstructive strategies and assess three testable predictions, although this was done without formal systematic review or original data collection.
Key Findings:
Substantial heterogeneity exists in donor selection, reconstructive strategies, and technical approaches.
Prediction 1: Worse outcomes correlate with increased lesion severity, consistently supported by literature.
Prediction 2: Superior outcomes with feasibility triad-compliant donor selection remain insufficiently evaluated.
Prediction 3: Technical modifications cannot fully compensate for poor donor feasibility, which was supported.
Interpretation:
The proposed framework provides a structured language for articulating donor choices and constraints, facilitating meaningful comparisons across diverse clinical scenarios.
Limitations:
No formal systematic review or original data collection was performed.
The focus is limited to adult patients with specific types of nerve injuries, which may affect the generalizability of the findings.
Conclusion:
Prospective validation of the predictions and standardized outcome reporting are essential to enhance interpretability and reproducibility across studies.
