J Reconstr Microsurg 2017; 33(09): 636-640
DOI: 10.1055/s-0037-1605365
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neurotization of the Superficial Sensory Branch of Ulnar Nerve by the Distal Posterior Interosseous Nerve: Cadaveric Feasibility Study

1   Department of Orthopaedic, Hôpital Pierre-Paul Riquet, Toulouse, France
2   Anatomy Laboratory, Faculty of Medicine, Toulouse, France
,
Laurent Decaestecker
1   Department of Orthopaedic, Hôpital Pierre-Paul Riquet, Toulouse, France
,
Stépahnie Delclaux
1   Department of Orthopaedic, Hôpital Pierre-Paul Riquet, Toulouse, France
,
Costel Apredoaei
1   Department of Orthopaedic, Hôpital Pierre-Paul Riquet, Toulouse, France
,
Meagan E. Tibbo
3   Department of Orthopaedic, Mayo Clinic, Rochester, Minnesota
,
Monique Courtade-Saïdi
4   Histology and Embryology Laboratory, Rangueil Medical School, Toulouse University, Toulouse, France
,
Pierre Mansat
1   Department of Orthopaedic, Hôpital Pierre-Paul Riquet, Toulouse, France
› Author Affiliations
Further Information

Publication History

20 May 2017

18 June 2017

Publication Date:
25 August 2017 (online)

Abstract

Background In 2014, Delclaux et al described a case wherein the Battiston and Lanzetta's technique, modified by utilization of the posterior interosseus nerve (PIN), was used to perform double neurotization of the ulnar nerve (UN). This study evaluates the feasibility of transfer of proprioceptive fascicles of the PIN to the superficial sensory branch of the UN (SSBUN).

Methods The surgeries were performed on 16 fresh cadaveric wrist specimens. PIN transfer was performed through the interosseous membrane and sutured to the SSBUN. The diameter for each nerve, number of fascicles, and the percentage of fascicles without axons, under ×10, ×40, and ×100 magnifications were performed by two observers.

Results Neurotization of the SSBUN by the PIN was successful in all cases. The median diameter of the SSBUN and PIN was 3.5 (3–4) and 2.3 mm (1.6–3), respectively. The SSBUN contained 5.5 fascicles (4–7), while the PIN contained 2 fascicles (0–4). The 16 PIN had limited (10 cases) or no axonal reserve (6 cases).

Conclusion This study supports the surgical and anatomical feasibility of neurotization of the SSBUN by the PIN. However, the PIN's limited axonal reserve may partially or totally compromise recovery.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.


Level of Evidence

The level of evidence is therapeutic IV.


Contribution of Authors

All the authors (P.L., L.D., S.D., C.A., M.E.T., M.C.S., and P.M.) certify that each author has participated in the content and design of the study, the preparation of the article and its revisions, and final approval.


Author's ORCID ID orcid.org/0000-0002-3019-9861.


 
  • References

  • 1 McAllister RM, Gilbert SE, Calder JS, Smith PJ. The epidemiology and management of upper limb peripheral nerve injuries in modern practice. J Hand Surg [Br] 1996; 21 (01) 4-13
  • 2 Jaquet JB, Luijsterburg AJ, Kalmijn S, Kuypers PD, Hofman A, Hovius SE. Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity. J Trauma 2001; 51 (04) 687-692
  • 3 Bruyns CN, Jaquet JB, Schreuders TA, Kalmijn S, Kuypers PD, Hovius SE. Predictors for return to work in patients with median and ulnar nerve injuries. J Hand Surg Am 2003; 28 (01) 28-34
  • 4 Roganovic Z. Missile-caused ulnar nerve injuries: outcomes of 128 repairs. Neurosurgery 2004; 55 (05) 1120-1129
  • 5 Murovic JA. Upper-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 1837 Louisiana State University Health Sciences Center median, radial, and ulnar nerve lesions. Neurosurgery 2009; 65 (4, Suppl): A11-A17
  • 6 Kankaanpää U, Bakalim G. Peripheral nerve injuries of the upper extremity. Sensory return of 137 neurorrhaphies. Acta Orthop Scand 1976; 47 (01) 41-45
  • 7 Vastamäki M, Kallio PK, Solonen KA. The results of secondary microsurgical repair of ulnar nerve injury. J Hand Surg [Br] 1993; 18 (03) 323-326
  • 8 Taha A, Taha J. Results of suture of the radial, median, and ulnar nerves after missile injury below the axilla. J Trauma 1998; 45 (02) 335-339
  • 9 Vordemvenne T, Langer M, Ochman S, Raschke M, Schult M. Long-term results after primary microsurgical repair of ulnar and median nerve injuries. A comparison of common score systems. Clin Neurol Neurosurg 2007; 109 (03) 263-271
  • 10 Lee SK, Wolfe SW. Nerve transfers for the upper extremity: new horizons in nerve reconstruction. J Am Acad Orthop Surg 2012; 20 (08) 506-517
  • 11 Seiler III JG, Desai MJ, Payne SH. Tendon transfers for radial, median, and ulnar nerve palsy. J Am Acad Orthop Surg 2013; 21 (11) 675-684
  • 12 Moore AM, Franco M, Tung TH. Motor and sensory nerve transfers in the forearm and hand. Plast Reconstr Surg 2014; 134 (04) 721-730
  • 13 Patterson JM. High ulnar nerve injuries: nerve transfers to restore function. Hand Clin 2016; 32 (02) 219-226
  • 14 Haase SC, Chung KC. Anterior interosseous nerve transfer to the motor branch of the ulnar nerve for high ulnar nerve injuries. Ann Plast Surg 2002; 49 (03) 285-290
  • 15 Novak CB, Mackinnon SE. Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg 2002; 18 (06) 459-464
  • 16 Battiston B, Lanzetta M. Reconstruction of high ulnar nerve lesions by distal double median to ulnar nerve transfer. J Hand Surg Am 1999; 24 (06) 1185-1191
  • 17 Brown JM, Yee A, Mackinnon SE. Distal median to ulnar nerve transfers to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery 2009; 65 (05) 966-977 , discussion 977–978
  • 18 Flores LP. Distal anterior interosseous nerve transfer to the deep ulnar nerve and end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve for treatment of high ulnar nerve injuries: experience in five cases. Arq Neuropsiquiatr 2011; 69 (03) 519-524
  • 19 Delclaux S, Aprédoaei C, Mansat P, Rongières M, Bonnevialle P. Case report: double nerve transfer of the anterior and posterior interosseous nerves to treat a high ulnar nerve defect at the elbow. Chir Main 2014; 33 (05) 320-324
  • 20 Robert M, Blanc C, Gasnier P, Le Nen D, Hu W. Neurotization of the deep branch of ulnar nerve with anterior interosseous nerve: anatomic study [in French]. Chir Main 2011; 30 (06) 406-409
  • 21 Jariwala A, Krishnan B, Soames R, Wigderowitz CA. Important anatomical relationships of the posterior interosseous nerve in the distal forearm for surgical planning: a cadaveric study. J Wrist Surg 2014; 3 (01) 60-63
  • 22 Lien SC, Cederna PS, Kuzon Jr WM. Optimizing skeletal muscle reinnervation with nerve transfer. Hand Clin 2008; 24 (04) 445-454 , vii
  • 23 Jacobs JM, Love S. Qualitative and quantitative morphology of human sural nerve at different ages. Brain 1985; 108 (Pt 4): 897-924
  • 24 Kanda T, Tsukagoshi H, Oda M, Miyamoto K, Tanabe H. Morphological changes in unmyelinated nerve fibres in the sural nerve with age. Brain 1991; 114 (Pt 1B): 585-599
  • 25 Verdú E, Ceballos D, Vilches JJ, Navarro X. Influence of aging on peripheral nerve function and regeneration. J Peripher Nerv Syst 2000; 5 (04) 191-208