Anterior Interosseous to Ulnar Motor Supercharge Nerve Transfer

The supercharge nerve transfer is a procedure that coapts the distal end of a donor nerve to the side of the recipient nerve. Nerve regeneration is facilitated from donor to recipient through a perineurial window to enhance regeneration from the proximal regenerating nerve. This procedure can be used in cases of 2nd/3rd degree nerve injuries to augment motor recovery, with the advantages of a nerve transfer and without sacrificing the integrity and proximal regeneration of the recipient nerve. In this case, the patient had an iatrogenic medial cord injury. She presented 7 months following injury with ulnar intrinsic atrophy and fibrillations/motor unit potentials in her ulnar extrinsic/intrinsic muscles. The supercharge anterior interosseous to ulnar motor nerve transfer was elected with a transmuscular ulnar nerve transposition, Guyon’s canal release, and FDP tenodesis. This video highlights details of the supercharge nerve transfer, with specifics on the perineurial coaptation, Guyon’s canal release, and FDP tenodesis.

Standard:

Extended:

POSITION

Supine.

INCISION

An incision is made ulnar to the thenar crease with a Brunner’s incision across the wrist and proximally across the distal forearm.

REFERENCES

1. 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.
2. Kale SS, Glaus SW, Yee A, Nicoson MC, Hunter DA, Mackinnon SE, Johnson PJ. Reverse end-to-side nerve transfer: from animal model to clinical use. J Hand Surg Am. 2011 Oct;36(10):1631-1639.e2. PMID: 21872405.
3. 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.
4. 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 Aug;18(6):459-64. PMID: 12177812.

Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.