Median nerves with neuromas-in-continuity are preferably managed by the identification and preservation of the functioning motor fascicles proximal and distal to the neuroma. The non-functioning, painful sensory fibers are divided proximally and distally and are reconstructed with nerve grafts. In cases where the proximal motor fascicle may not be safely and effectively isolated because of scarring or previous surgical intervention, the distal anterior interosseous nerve (dAIN) may be grafted to the recurrent motor branch of the median (RMB) nerve distal to the neuroma. The primarily motor fibers of the dAIN provide an expendable donor of adequate size and fascicle number to restore thenar muscle function.
KEYWORDS
Neuroma-in-continuity - recurrent motor branch of median nerve - nerve transfer
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Susan E MackinnonM.D.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine
Suite 17424, East Pavilion, One Barnes-Jewish Hospital Plaza
St. Louis, MO 63110
