For distal sensory ulnar nerve injuries in the hand, there is an alternative approach in restoration of critical ulnar nerve sensation. In this case, the patient had a gunshot wound and required amputation of the small finger. As result, the ulnar aspect of the ring finger became the critical target for sensory reinnervation. In addition, soft tissue coverage of the palm was an obstacle for long nerve grafts. Goals were to restore critical sensation and prevent painful neuroma formation. The median nerve branch to the ulnar aspect of the index finger was used as the donor nerve to reinnervate the recipient ulnar nerve branch to the ulnar aspect of the ring finger. A nerve graft was required to bridge the distance and the ulnar sensory fascicle proximal to the injury was harvested as expendable graft material. An acellularized nerve allograft is used to extend the proximal end of the ulnar sensory fascicle for proximal transposition. To preserve rudimentary sensation to the donor nerve, an end-to-side nerve transfer to the lateral aspect of the long finger is completed.
The reconstruction of critical ulnar ring finger sensation involves multiple incisions. The first incision is made on the ulnar aspect of the distal forearm to expose the ulnar nerve proximal to the area of injury. The second incision is made on the ulnar aspect of the ring finger to expose the recipient ulnar nerve. The third incision is made on the 2nd web space to the ulnar aspect of the index finger to expose the donor median nerve.
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Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.