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Distal nerve transfer from the median nerve lumbrical fibers to the distal ulnar nerve motor branches in the palm: An anatomical cadaveric study
Author(s) -
Colonna Michele R.,
Pino Davide,
Battiston Bruno,
d'Alcontres Francesco Stagno,
Natsis Konstantinos,
Bassetto Franco,
Papadopulos Nikolaos A.,
Tiengo Cesare,
Geuna Stefano
Publication year - 2019
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.30402
Subject(s) - medicine , ulnar nerve , anatomy , median nerve , cadaveric spasm , motor nerve , trunk , elbow , biology , ecology
Background The aim of the current study is to investigate the first and second lumbrical nerves as potential fibers donors to the deep motor branch of the ulnar nerve to avoid intrinsic atrophy in high ulnar nerve injuries. Methods Sixteen fresh frozen cadaveric hands were dissected, the radial lumbrical nerves accessed, and a coaptation, either in reverse end‐to‐side or in double end‐to‐side through a bridge nerve graft, was created to the deep motor branch of ulnar nerve. Semithin sections were taken from samples of donor and recipient nerves for qualitative (nerve architecture) and quantitative studies (fiber count and donor/recipient ratio). Results The first lumbrical showed a robust trunk and a superior axon density (9,126.50 ± 2,923.41 axons/mm 2 ) to the ulnar motor branch (7,506.50 ± 1,137.50 axons/mm 2 distal to the opponens tunnel and 7,947.75 ± 1,741.24 axons/mm 2 before its terminal branching); the ulnar motor branch showed a higher axon number (2,633.51 ± 410.00 distal to the opponens tunnel and 2,345.75 ± 2,101.56 before its terminal branching) than the first lumbrical (1,410.56 ± 823.89); section areas occupied by axons were higher in proximal (0.20 ± 0.16) and distal (0.26 ± 0.20) ulnar samples than the first lumbrical (0.17 ± 0.16). Donor/recipient ratio first lumbrical/deep motor branch of the ulnar nerve were 1:1.86 (distal to the opponens tunnel) and 1:1.67 (at its terminal branching); data about the second lumbrical were ruled out because of bias. Conclusions A transfer from the first lumbrical nerve to the deep motor branch of the ulnar nerve in palm is suitable to avoid intrinsic atrophy.