Life Neuroscience

Peripheral nerve injuries result in profound motor and sensory deficits that limit functional recovery. Peripheral nerve transfers (PNTs) provide a surgical approach to restore meaningful function by redirecting healthy donor nerves to critical targets, shortening regeneration distances, and facilitating cortical adaptation. Successful recovery depends not only on precise surgical technique but also on the central nervous system’s ability to reorganize. Cortical plasticity after nerve transfer involves unmasking latent pathways, axonal sprouting, and gradual remapping of motor and sensory cortical areas. Recovery is influenced by donor–recipient nerve selection, surgical timing, patient age, and structured rehabilitation, including task-specific training and neuromodulation. Early intervention within the critical window enhances functional outcomes, prevents maladaptive plasticity, and supports voluntary motor control. Imaging and electrophysiological studies demonstrate dynamic shifts in cortical maps, interhemispheric recruitment, and hybrid motor representations. Integrating surgical planning with individualized rehabilitation and translational neuromodulatory strategies is key to optimizing functional recovery. This review summarizes current evidence on cortical reorganization following PNTs, bridging mechanistic insights with clinical practice.