Supinator to ulnar nerve transfer via in situ anterior interosseous nerve bridge to restore intrinsic muscle function in combined proximal median and ulnar nerve injury: a novel cadaveric study

In five cases of total root avulsion injury of brachial plexus, the thenar branch of the median nerve and the deep branch of the ulnar nerve were sutured to the branches of the femoral nerve during the procedure of intercostal, phrenic, accessory nerve transfer to the nerve trunks. The suture of the distal median or ulnar nerve in the hand to the femoral nerve was to maintain intrinsic muscles and prevent their atropy before arrival of nerve regeneration from the proximal end. The suture of the nerves was protected by wrapping it by abdominal flaps. The median and the ulnar nerve branches were separated from the femoral nerve when the NAP or SEP became detectable (about 1.5 years after the initial surgery). Good function of intrinsic muscles of the hand was observed in these five cases during the course of follow-up of the initial surgery, but the nerve recovery was not good after resuture of the median and the ulnar nerves. It was suggested from this preliminary clinical observation that suture of the distal median and ulnar nerves with the other nerves is effective in preservation of intrinsic muscle function, but recovery of intrinsic muscle function by resuture of the median and the ulnar nerves is not good.

Download Full-text

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.

Download Full-text

Early nerve protection with anterior interosseous nerve in modified end-to-side neurorrhaphy repairs high ulnar nerve injury: a hypothesis of a novel surgical technique

Artificial Cells Nanomedicine and Biotechnology ◽

10.3109/21691401.2013.848873 ◽

2013 ◽

Vol 43 (2) ◽

pp. 103-105 ◽

Cited By ~ 5

Author(s):

Qingtian Li ◽

Peixun Zhang ◽

Xiaofeng Yin ◽

Baoguo Jiang

Keyword(s):

Surgical Technique ◽

Nerve Injury ◽

Ulnar Nerve ◽

Anterior Interosseous Nerve ◽

Ulnar Nerve Injury

Download Full-text

“In Situ Vascular Nerve Graft” for Restoration of Intrinsic Hand Function: An Anatomical Study

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518500297 ◽

2018 ◽

Vol 23 (02) ◽

pp. 248-254

Author(s):

Kamran Mozaffarian ◽

Hamid Reza Zemoodeh ◽

Mohammad Zarenezhad ◽

Mohammad Owji

Keyword(s):

Ulnar Nerve ◽

Hand Function ◽

Anatomical Study ◽

Nerve Transfer ◽

Nerve Graft ◽

Posterior Interosseous Nerve ◽

Motor Branch ◽

Ulnar Nerve Injury ◽

High Median

Background: In combined high median and ulnar nerve injury, transfer of the posterior interosseous nerve branches to the motor branch of the ulnar nerve (MUN) is previously described in order to restore intrinsic hand function. In this operation a segment of sural nerve graft is required to close the gap between the donor and recipient nerves. However the thenar muscles are not innervated by this nerve transfer. The aim of the present study was to evaluate whether the superficial radial nerve (SRN) can be used as an “in situ vascular nerve graft” to connect the donor nerves to the MUN and the motor branch of median nerve (MMN) at the same time in order to address all denervated intrinsic and thenar muscles. Methods: Twenty fresh male cadavers were dissected in order to evaluate the feasibility of this modification of technique. The size of nerve branches, the number of axons and the tension at repair site were evaluated. Results: This nerve transfer was technically feasible in all specimens. There was no significant size mismatch between the donor and recipient nerves Conclusions: The possible advantages of this modification include innervation of both median and ulnar nerve innervated intrinsic muscles, preservation of vascularity of the nerve graft which might accelerate the nerve regeneration, avoidance of leg incision and therefore the possibility of performing surgery under regional instead of general anesthesia. Briefly, this novel technique is a viable option which can be used instead of conventional nerve graft in some brachial plexus or combined high median and ulnar nerve injuries when restoration of intrinsic hand function by transfer of posterior interosseous nerve branches is attempted.

Download Full-text