2018/01/31
Combined proximal median and ulnar nerve injury is extremely difficult to treat, because a timely successful reinnervation in such proximal injury is unlikely to occur. Here, we used a safe strategy to manage such incapacitating injury in the form of direct transfer of abductor pollicis longus (APL) nerve to the motor fascicles of the ulnar nerve, using the proximal ulnar nerve itself as a graft for the median nerve defect, combined with simultaneous extensor indicis proprius (EIP) opponoplasty. End-to-side transfer of the distal sensory fascicles of the ulnar nerve to the superficial radial nerve at the mid-forearm level was performed. We applied this management strategy to a 14-year-old female who suffered an extensive injury of both median and ulnar nerves at the distal arm level. After 14 months of regular follow up, the patient effectively restored both intrinsic and extrinsic hand functions and variable sensory recovery with minimal morbidity.
Ghoraba SM, Elshawadfy SE, Shoukr TG, Mahmoud WH, Ayad HM. Innovative Management Strategy for Combined Proximal Median and Ulnar Nerve Extensive Injury: A Case Report. International Microsurgery Journal 2018;1(4):1. DOI: 10.24983/scitemed.imj.2018.00051
