J Reconstr Microsurg 2002; 18(6): 459-464
DOI: 10.1055/s-2002-33326
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Distal Anterior Interosseous Nerve Transfer to the Deep Motor Branch of the Ulnar Nerve for Reconstruction of High Ulnar Nerve Injuries

Christine B. Novak, Susan E. Mackinnon
  • Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
Further Information

Publication History

Publication Date:
14 August 2002 (online)

ABSTRACT

Proximal ulnar nerve injuries can result in loss of intrinsic muscle function of the hand, and distal nerve transfers provide nerve coaptation close to the target muscle. This retrospective chart review evaluated patient outcome following a distal nerve transfer of the anterior interosseous nerve (AIN) to the deep motor branch of the ulnar nerve. There were eight patient charts reviewed, three women, and five men. The mean patient age was 38 years (standard deviation: 22 years). The mean time from injury to surgery was 3 months (standard deviation: 3 months), and mean postoperative follow-up time was 18 months (standard deviation: 11 months). All patients had reinnervation of the ulnar nerve intrinsic hand muscles with improved postoperative lateral pinch and grip strength. One patient had a secondary tendon transfer. No functional deficit in performing tasks in pronation was reported. The distal nerve transfer of the AIN to the deep motor branch of the ulnar nerve provides good reinnervation of the ulnar-nerve-innervated intrinsic muscles of the hand.

REFERENCES

  • 1 Mackinnon S E, Dellon A L. Surgery of the Peripheral Nerve.  New York: Thieme Medical Publishers 1988
  • 2 Kline D G, Hudson A R. Nerve Injuries-Operative Results for Major Nerve Injuries, Entrapment and Tumors.  Philadelphia: W.B. Saunders 1995
  • 3 Mackinnon S E, Novak C B. Nerve transfers.  Hand Clin . 1999;  15 643-666
  • 4 Schultz R J, Aiache A. An operation to restore opposition of the thumb by nerve transfer.  Arch Surg . 1972;  105 777-779
  • 5 Nath R K, Mackinnon S E, Shenaq S M. New nerve transfers following peripheral nerve injuries. In: Operative Techniques in Plastic and Reconstructive Surgery 1997 4: 2-11
  • 6 Wang Y, Zhu S. Transfer of a branch of the anterior interosseous nerve to the motor branch of the median and ulnar nerve.  Chin Med J . 1997;  110 216-219
  • 7 Chuang DC-C, Yeh M-C, Wei F-C. Intercostal nerve transfer of the musculocutaneous nerve in avulsed brachial plexus injuries: evaluation of 66 patients.  J Hand Surg . 1992;  17A 822-828
  • 8 Chuang DC-C, Lee G W, Hashem F, Wei F-C. Restoration of shoulder abduction by nerve transfer in avulsed brachial plexus injury: evaluation of 99 patients with various nerve transfers.  J Hand Surg . 1995;  96 122-128
  • 9 Narakas A O. Neurotization in the treatment of brachial plexus injuries. In: Gelberman RH, ed. Operative Nerve Repair and Reconstruction Philadelphia: J.B. Lippincott Company 1991: 1329-1358
  • 10 Narakas A O. Thoughts on neurotization or nerve transfers in irreparable nerve lesions.  Clin Plast Surg . 1984;  11 153-159
  • 11 Samardzic M, Grujicic D, Antunovic V. Nerve transfer in brachial plexus traction injuries.  J Neurosurg . 1992;  76 191-197
  • 12 Walkakul S, Wongtragul S, Vanadurongwan V. Restoration of elbow flexion in brachial plexus avulsion injury: comparing spinal accessory nerve transfer with intercostal nerve transfer.  J Hand Surg . 1999;  24A 571-577
  • 13 Battison B, Lanzetta M. Reconstruction of high ulnar nerve lesions by distal double median to ulnar nerve transfer.  J Hand Surg . 1999;  24A 1185-1191
  • 14 Fu S Y, Gordon T. Contributing factors to poor functional recovery after delayed nerve repair: prolonged denervation.  J Neurosci . 1995;  15 3886-3895
  • 15 Lurje A. Concerning surgical treatment of traumatic injury of the upper division of the brachial plexus (Erb's type).  Ann Surg . 1948;  127 317-326
  • 16 Millesi H. Microsurgery of peripheral nerves.  Hand . 1973;  5 157-160
  • 17 Millesi H, Meissl G, Berger A. Further experience with interfascicular grafting of the median, ulnar and radial nerves.  J Bone Joint Surg . 1976;  58A 209-218
  • 18 Ustun M E, Ogun T C, Buyukmumcu M, Salbacak A. Selective restoration of motor function in the ulnar nerve by transfer of the anterior interosseous nerve.  J Bone Joint Surg . 2001;  83A 549-552
  • 19 Lutz B S, Chuang DC-C, Chuang S S. Nerve transfer to the median nerve using parts of the ulnar and radial nerves in the rabbit-effects on motor recovery of the median nerve and donor nerve morbidity.  J Hand Surg . 2000;  25B 329-335
  • 20 Oberlin C, Beal D, Leechavengvongs S. Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: anatomical study and report of four cases.  J Hand Surg . 1994;  19A 232-237
  • 21 May M. Nerve substitution techniques: XII-VII hook-up, XII-VII jump graft, and cross-facial graft. In: May M, Schaitkin BM, eds. The Facial Nerve New York: Thieme 2000: 611-634
  • 22 Tarasidis G, Watanabe O, Mackinnon S E. End-to-side neurorrhaphy resulting in limited sensory axonal regeneration in a rat model.  Ann Oto Rhinol Laryngol . 1997;  106 506-512
  • 23 Dellon A L. Tendon transfer to correct adducted little finger in ulnar dysfunction.  J Hand Surg . 2001;  16A 819-823