Modern advancements with a rejuvenation of nerve-to-nerve transfer procedures (nerve transfers) that move the reconstruction closer to the target have created a renaissance in peripheral nerve surgery, particularly with respect to brachial plexus reconstruction, with great potential for much-improved patient outcomes.It is well known that denervated motor end plates lose their reinnervation potential and denervated muscle atrophies after 12 to 18 months in the adult population. Given our inability-as yet-to increase the rate of nerve regeneration, a logical solution to the problem of a nerve injury much more proximal to its target than the physiologic time clock allows is to convert the high injury to a low injury in an effort to speed motor end plate reinnervation and preserve muscle structure and function. Nerve transfers are a natural and elegant way to accomplish this goal. With this technique, a redundant or expendable intact donor nerve is transferred to the distal end of an injured nerve much closer to its end organ.