The use of extraplexus intercostal nerve harvest and transfer, targeting the musculocutaneous or axillary nerves, for the management of brachial plexus injuries, has the distinct advantages of availability even in the setting of proximal nerve injury (preganglionic) as well as limited donor site morbidity. Branching from the ventral rami of associated thoracic nerves to run along the caudal aspect of each rib, intercostal nerves are composed of two cutaneous (anterior and lateral) and one motor branch running caudal to their corresponding artery and vein. Despite the comparatively small motor fiber concentration of intercostal nerves, the use of 2–4 intercostal nerves has been shown to achieve sufficient restoration of elbow flexion via reconstruction of the musculocutaneous nerve, particularly the branch to the biceps brachii or brachialis.