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

Introduction

Neurofibromatosis type 1 (NF1) is an autosomal dominant syndrome with a tendency to develop skin tumours, peripheral nerve sheath tumours and hyperpigmented café-au-lait spots. The most common tumours detected in a proportion of patients are cutaneous (dermal) neurofibromas and plexiform (diffuse) neurofibromas [1], [2]. The former lesions are limited in size and superficially located. The latter tumours arise from nerve trunks, are large in size and often extend far into several body regions. Solitary neurofibromas of the nerves are not common in patients without diagnosis of NF1, and if so, it may represent a specific variant called a “segmental NF1”. The standard treatment of benign lesions include local excision, often with intrafascicular dissection with nerve preservation. Wide surgical resection with or without nerve reconstruction is recommended for malignant tumours. Recurrences are fairly common after sparing surgery and when they occur, they require more radical excision, followed by nerve repair.

In this article we present a technique applied for recovery of the ulnar nerve function after its wide resection in the arm due to recurrent plexiform neurofibroma. As timely reinnervation of the intrinsic muscles in the hand was uncertain, except of standard nerve grafting we used nerve-to-nerve transfer to accelerate and make restoration of the nerve function more likely. Finally, recovery of the ulnar nerve function did not occur (failed), but we believe that the presented technique may be interesting for hand surgeons dealing with the treatment of large nerve defects.

Publication History

Article published online:
12 October 2021

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