INTRODUCTION: We review the role of neuroplasticity in functional recovery after peripheral nerve transfers, with a focus on its contribution beyond simple restoration of muscle strength.
METHODS: A narrative review of the literature from the past three decades was conducted. Peripheral nerve transfer techniques were examined with emphasis on adaptive changes within the central nervous system. Key clinical and experimental evidence was synthesized to highlight the mechanisms, advantages, and limitations of neuroplasticity.
RESULTS: Functional recovery following nerve transfer depends not only on peripheral reconstruction but also on central adaptations. Although outcomes are often reported using muscle strength grading, this approach neglects critical aspects of coordination, selective control, and integration into complex motor tasks. Neuroplasticity facilitates meaningful function by enabling cortical and subcortical reorganization, but it also presents limitations related to variability, incomplete adaptation, and dependence on donor motor programmes. Review of the available evidence indicates that while neuroplasticity is indispensable to successful nerve transfer outcomes, it cannot fully overcome the intrinsic constraints of the donor-recipient mismatch.
CONCLUSIONS: Peripheral nerve transfers must be assessed within the broader framework of neuroplasticity. A balanced understanding of this mechanism - its reliability, benefits, and inherent limitations - provides an up-to-date perspective for clinicians and researchers. Such knowledge is essential to refine reconstructive strategies, optimize rehabilitation and align patient expectations with achievable functional outcomes.
LEVEL OF EVIDENCE: IV.
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