Sensory nerve transfers are an available option for restoring sensation to critical deinnervated territories. Multiple strategies exist for restoring sensation, which include end-to-end nerve transfers for critical territories and end-to-side nerve transfers for non-critical territories. For sensory deficits in the ulnar nerve, the 3rd webspace fascicle from the median nerve can be utilized as a donor to reinnervate the ulnar territory of the hand, also known as the median to ulnar sensory nerve transfer. In this case, the patient suffered a traumatic ulnar nerve injury that was referred to our institution several years following for neuropathic pain. This was the patient’s chief compliant and became the management priority. An ulnar nerve transection, proximal crush, cautery cap, and proximal transposition were elected. While this resolves the neuroma component of pain, there can still exist a hyperalgesia component, which distal nerve transfers would resolve through reinnervation. This video details the 3rd webspace to sensory component of the ulnar (end-to-end) nerve transfer. The distal 3rd webspace nerve was end-to-side transferred to the sensory component of the median nerve. Additionally, the palmar cutaneous branch of median nerve was (end-to-end) transferred to the dorsal cutaneous branch of ulnar nerve.
An incision is made ulnar to the thenar crease with a Brunner’s incision over the wrist crease and a proximal forearm incision.
- Boyd KU, Nimigan AS, Mackinnon SE. Nerve reconstruction in the hand and upper extremity. Clin Plast Surg. 2011 Oct;38(4):643-60. Review. PMID: 22032591.
- Fox IK, Mackinnon SE. Adult peripheral nerve disorders: nerve entrapment, repair, transfer, and brachial plexus disorders. Plast Reconstr Surg. 2011 May;127(5):105e-118e. Review. PMID: 21532404.
- Tung TH, Mackinnon SE. Nerve transfers: indications, techniques, and outcomes. J Hand Surg Am. 2010 Feb;35(2):332-41. Review. PMID: 20141906.
- 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 Nov;65(5):966-77; discussion 977-8. PMID: 19834412.
- Brown JM, Mackinnon SE. Nerve transfers in the forearm and hand. Hand Clin. 2008 Nov;24(4):319-40, v. Review. PMID: 18928884.
- Pannucci C, Myckatyn TM, Mackinnon SE, Hayashi A. End-to-side nerve repair: review of the literature. Restor Neurol Neurosci. 2007;25(1):45-63. Review. PMID: 17473395.
- Tarasidis G, Watanabe O, Mackinnon SE, Strasberg SR, Haughey BH, Hunter DA. End-to-side neurorrhaphy resulting in limited sensory axonal regeneration in a rat model. Ann Otol Rhinol Laryngol. 1997 Jun;106(6):506-12. PMID: 9199612.
Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.