Response to the Comment on the Article Titled: "Combined Reconstruction of the Ulnar Nerve After its Wide Resection by Nerve Grafting at the Site of the Resection and Distal Transfer of the Anterior Interosseus Nerve to the Deep Branch of the Ulnar Nerve".

Abstract

The authors thank very much for the critical comment on our article. We agree with all critical arguments concerning not really correct selection of the patient to this type of operation. We agree with an argument that long time of complete ulnar nerve palsy might cause degeneration of the motor end plates at the time of reconstruction. In this situation neither reconstruction done in our patient had chance to work. Nevertheless, the final outcome was surprisingly good, in spite of no improvement of the ulnar nerve function. As we stated in the article, it may be partly explained by successful treatment of the pain that the patient experienced for a long time. The uncontrolled pain in the course of CRPS constituted the primary problem in our patient at presentation and it was successfully eliminated by continuous brachial plexus analgesia. Likewise, the resection of a large fragment of the nerve with recurrent tumours probably resulted in additional alleviating the pain. There was also no recurrence of the pain after main operation. Accepting all critical comments the authors believe that this case can incline surgeons to more careful consideration the treatment options which are the most beneficial for the patient with long-lasting nerve palsy. The lesson we learned from this case and from the comment is that sophisticated surgery is not necessary the best solution in difficult clinical case and that ground for decision making should not be surgeons’ ambitions, but scientific evidence and rational thinking.