Reconstruction of high ulnar nerve lesions by distal double neurotization using motor and sensory branches from the median nerve

Abstract

Background High ulnar nerve lesions often have a poor prognosis as a result of the long distance between the site of injury and the innervated intrinsic muscles of the hand. Even with the most meticulous microsurgical repair, some cross innervations show poor recovery. Patients and methods There were four patients with irreparable high ulnar nerve lesion, three men and one woman. The mean age of the patients at surgery was 24 years (range from 17 to 38 years). The mean time from injury to surgery was 3.3 months (range from 2.5 to 5 months). Reconstruction of irreparable high ulnar nerve lesion was performed by transfer of two terminal branches from the median nerve, the anterior interosseous nerve supplying pronator quadratus muscle and palmar cutaneous branch, to the motor and sensory branches of the ulnar nerve at the level of the wrist. The mean postoperative follow-up duration was 22 months (range from 12 to 38 months). Results Results were graded using the Highet-Zachary scale. Good motor and sensory recovery was observed in three cases. The remaining case had only a protective sensation and required a secondary tendon transfer. No functional deficit in pronation occurred. Conclusion Although the number of patients in our report is small, the procedure provides a good option to restore the ulnar nerve functions in cases of irreparable high ulnar nerve lesion. The procedure is easy to perform, with minimal donor-site morbidity.