"Babysitting" procedures in proximal nerve trunk injuries: two case reports and a review

Abstract

One of the most important goals in treating proximal nerve injuries is to maintain the function of distal effectors during axonal regeneration. Babysitting, that is, connecting the injured nerve to a healthy trunk provides a bypass for distal neural regeneration or reactivation. It avoids degeneration of sensory and motor terminations, with minimal donor nerve damage. We present a technique where a nerve graft is used between ulnar and median nerve through two end-to-side sutures in the distal third of the forearm, in two different cases of proximal ulnar nerve injury. Both patients were young manual workers, the former suffered a total nerve disruption proximal to the elbow following a car accident and the latter suffered a perineurial scar from a high voltage injury at the proximal third of the forearm. The proximal injury was grafted with a sural nerve in the former and treated by neurolysis in the latter. Results were graded by the Highet-Zachary scale for both sensory and motor recovery. The outcomes of our series were compared to six other case reports in the literature (including median nerves) treated with this technique. Both clinical and experimental data show that babysitting effectively protects distal effectors.