3rd Webspace to Sensory Component of Ulnar Nerve Transfer and PCM to DCU Nerve Transfer

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.

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