Nerve Transfer Versus Nerve Graft for Reconstruction of High Ulnar Nerve Injuries

OBJECTIVE: To demonstrate the results of a double nerve transfer at the level of the hand for recovery of the motor and sensory function of the hand in cases of high ulnar nerve injuries. METHOD: Five patients underwent a transfer of the distal branch of the anterior interosseous nerve to the deep ulnar nerve, and an end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve. RESULTS: Two patients recovered strength M3 and three cases were graded as M4; recovery of protective sensation (S3+ in three patients and S4 in two) was observed in the fourth and fifth fingers, and at the hypothenar region. The monofilament test showed values of 3.61 or less in all cases and the two-point discrimination test demonstrated values of 7 mm in three cases and 5 mm in two. CONCLUSION: This technique of double nerve transfer is effective for motor and sensory recovery of the distal ulnar-innervated side of the hand.

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Future Perspectives in the Management of Nerve Injuries

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1639353 ◽

2018 ◽

Vol 34 (09) ◽

pp. 672-674 ◽

Cited By ~ 14

Author(s):

Susan Mackinnon

Keyword(s):

Brachial Plexus ◽

Nerve Repair ◽

Nerve Transfer ◽

Functional Results ◽

White Paper ◽

Nerve Graft ◽

Nerve Injuries ◽

Nerve Grafts ◽

Nerve Transfers ◽

Reconstructive Microsurgery

Aim The author presents a solicited “white paper” outlining her perspective on the role of nerve transfers in the management of nerve injuries. Methods PubMed/MEDLINE and EMBASE databases were evaluated to compare nerve graft and nerve transfer. An evaluation of the scientific literature by review of index articles was also performed to compare the number of overall clinical publications of nerve repair, nerve graft, and nerve transfer. Finally, a survey regarding the prevalence of nerve transfer surgery was administrated to the World Society of Reconstructive Microsurgery (WSRM) results. Results Both nerve graft and transfer can generate functional results and the relative success of graft versus transfer depended on the function to be restored and the specific transfers used. Beginning in the early 1990s, there has been a rapid increase from baseline of nerve transfer publications such that clinical nerve transfer publication now exceeds those of nerve repair or nerve graft. Sixty-two responses were received from WSRM membership. These surgeons reported their frequency of “usually or always using nerve transfers for repairing brachial plexus injuries as 68%, radial nerves as 27%, median as 25%, and ulnar as 33%. They reported using nerve transfers” sometimes for brachial plexus 18%, radial nerve 30%, median nerve 34%, ulnar nerve 35%. Conclusion Taken together this evidence suggests that nerve transfers do offer an alternative technique along with tendon transfers, nerve repair, and nerve grafts.

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Anterior Interosseous Nerve to Ulnar Nerve Transfers: A Systematic Review

Journal of Hand and Microsurgery ◽

10.1055/s-0041-1734399 ◽

2021 ◽

Author(s):

Melanie D. Luikart ◽

Justin M. Kistler ◽

David Kahan ◽

Richard McEntee ◽

Asif M. Ilyas

Keyword(s):

Grip Strength ◽

Nerve Injury ◽

Ulnar Nerve ◽

Nerve Graft ◽

Pinch Strength ◽

Nerve Injuries ◽

Nerve Transfers ◽

Strength Recovery ◽

Anterior Interosseous Nerve ◽

Ulnar Nerve Injury

Abstract Background There has been an increasing utilization of end-to-end (ETE) and reverse “supercharged” end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers (NTs) for treatment of high ulnar nerve injury. This study aimed to review the potential indications for, and outcomes of, ETE and SETS AIN–ulnar NT. Methods A literature review was performed, and 10 articles with 156 patients who had sufficient follow-up to evaluate functional outcomes were included. English studies were included if they reported the outcome of patients with ulnar nerve injuries treated with AIN to ulnar motor NT. Outcomes were analyzed based on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip and key pinch strength, and interosseous Medical Research Council–graded motor strength. Comparisons were made using the independent t-test and the chi-square test. No nerve graft control group was required for eligibility. Ulnar nerve injury types varied. Results NT resulted in 77% of patients achieving M3+ recovery, 53.7 ± 19.8 lb grip strength recovery, 61 ± 21% key pinch recovery, and a mean DASH score of 33.4 ± 16. In this diverse group, NT resulted in significantly greater M3+ recovery and grip strength recovery measured in pounds than in the nerve graft/conventional treatment group, and ETE repairs had significantly better outcomes compared with SETS repairs for grip strength, key pinch strength, and DASH scores, but heterogeneity limits interpretation. Conclusion ETE and SETS AIN–ulnar NTs produce significant restoration of ulnar nerve motor function for high ulnar nerve injuries. For ulnar nerve transection injuries at or above the elbow, ETE NT results in superior motor recovery compared with nerve grafting/conventional repair. However, further research is needed to determine the best treatment for other types of ulnar nerve injury and the role of SETS NT.

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An Experimental Study of Contralateral C7 Root Transfer with Vascularized Nerve Grafting to Treat Brachial Plexus Root Avulsion

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(94)90051-5 ◽

1994 ◽

Vol 19 (1) ◽

pp. 60-66 ◽

Cited By ~ 27

Author(s):

L. CHEN ◽

Y-D. GU

Keyword(s):

Brachial Plexus ◽

Ulnar Nerve ◽

Phrenic Nerve ◽

Nerve Transfer ◽

Nerve Graft ◽

Functional Evaluation ◽

Nerve Grafting ◽

Root Avulsion ◽

Nerve Grafts ◽

Healthy Side

Experimental rat models of simulated brachial plexus injuries were devised to compare the effect of contralateral C7 root transfer with phrenic neurotization. The effect of vascularized nerve grafting (VNG) was also compared with the use of conventional nerve grafts (CNG) in the treatment of root avulsion of the brachial plexus. 160 rats were randomly divided into four groups of 40 each; contralateral C7 root transfer with a vascularized ulnar nerve graft (C7-VNG), contralateral C7 root transfer with conventional ulnar nerve grafting (C7-CNG), ipsilateral phrenic nerve transfer with a vascularized ulnar nerve graft (P-VNG) and ipsilateral phrenic nerve transfer with conventional ulnar nerve grafting (P-CNG). Electrophysiological and histological examinations and functional evaluation were performed at different post-operative intervals. C7 root transfer was found to be superior to phrenic nerve transfer and VNG superior to CNG. Severance of the C7 nerve root was not found to affect limb function on the healthy side.

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DISTAL MEDIAN TO ULNAR NERVE TRANSFERS TO RESTORE ULNAR MOTOR AND SENSORY FUNCTION WITHIN THE HAND

Neurosurgery ◽

10.1227/01.neu.0000358951.64043.73 ◽

2009 ◽

Vol 65 (5) ◽

pp. 966-978 ◽

Cited By ~ 61

Author(s):

Justin M. Brown ◽

Andrew Yee ◽

Susan E. Mackinnon

Keyword(s):

Ulnar Nerve ◽

Case Reports ◽

Nerve Transfer ◽

Sensory Function ◽

Wrist Flexion ◽

Nerve Injuries ◽

Motor Branch ◽

Nerve Transfers ◽

Ulnar Nerve Palsy ◽

Intrinsic Function

Abstract ULNAR NERVE INJURIES can be severely debilitating and result in weakness of wrist flexion, loss of hand intrinsic function, and ulnar-sided hand anesthesia. When these injuries produce a Sunderland fourth- or fifth-degree injury, surgical intervention is necessary for functional recovery. Traditional methods for restoring hand intrinsic function after ulnar nerve palsy include interposition nerve grafting for timely presentations or tendon transfers for either complex injuries or late presentations. Distal median to ulnar nerve transfer to restore ulnar intrinsic nerve muscle function was first performed in 1991. We continue to find it advantageous for recovery of ulnar intrinsic function in patients with proximal ulnar nerve injuries by significantly reducing denervation time and directing motor fibers into this critical motor distribution. Several case reports have been published discussing the concept behind this approach, but none have outlined the specific steps involved in this operation. As such, this article discusses our operative methodology behind the distal median to ulnar neurotization, which includes a Guyon canal release, identification of donor median and recipient ulnar nerve fascicular anatomy within the forearm, and an operative tutorial on proper technique for neurotization to restore both ulnar motor and sensory function. We present the technical nuances of the following nerve transfers to restore ulnar nerve function within the hand: anterior interosseous nerve to deep motor branch of ulnar nerve, third webspace sensory contribution of median nerve to volar sensory component of ulnar nerve, and end-to-side reinnervation of ulnar dorsal cutaneous to the remaining median sensory trunk.

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