Refinements in nerve to muscle neurotization.

A modified surgical technique is introduced, enabling restoration of muscle function with direct muscular neurotization. Reliable clinical outcomes result from this technique. We report on a series of 10 patients in whom the supplying motor nerve had been lost at the level of the neuromuscular junction as the result of trauma or tumor resection. Our modification of the operative technique ensures a wide distribution of nerve fibers throughout the remaining muscle tissue and produces a mean motor recovery of M4 after a period of 1 to 2 years.