Artikel
Nerve transfer to restore thenar muscle in low median nerve palsy
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Autoren
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M. Rosa Morro
- Traumaunit, Centro Medico Teknon, Hospital Clínic de Barcelona, Departamento de Anatomía y Embriología Humana, UB, Sant Cugat del Valles, Spain
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Joaquim Casanas
- Traumaunit, Centro Medico Teknon, Sant Cugat del Valles, Spain
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Manuel Llusa
- Traumaunit, Centro Medico Teknon, Hospital Clínic de Barcelona, Departamento de Anatomía y Embriología Humana, UB, Sant Cugat del Valles, Spain
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Isabel Fernandez Conejero
- Traumaunit, Centro Medico Teknon, Sant Cugat del Valles, Spain
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Diana Ortega
- Traumaunit, Centro Medico Teknon, Sant Cugat del Valles, Spain
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Nerve transfer has changed peripheral nerve and brachial plexus expectations to restore function of damaged nerves. Several transfers have been described for multiple lack of function and each patient must be studied carefully in order to offer the best plan to recover function.
Anterior interosseous nerve (NIA) has been described to restore ulnar motor function in patients with ulnar nerve palsy, severe compression or low brachial plexus injuries. We decided to use NIA as a motor nerve to restore thenar muscle function in a selected group of patients with no motor thenar function and viability of NIA after partial brachial plexus injury. Accurate nerve conductions studies (NCS) are crucial to indicate this nerve transfer.
Methods: According to this principles, 3 patients have been treated during 2014 -2015, age ranges from 28 to 57 yo, 2 females and one male. Preoperative diagnosis supported by precise NCS is crucial to be sure pronator quadratus function is normal, as well it was uninjured or successful reinnervated
Surgical technique was assisted by intraoperative nerve recording (INR) to identify any residual nerve action potential (NAP) in the motor branch of the median nerve or compound motor action potential in the thenar muscles (CMAP). This way, intraneural dissection is avoided in cases with some or no activity, nerve dissection was performed from distal to proximal to identify fascicular group track to thenar muscle. Reverse end-to-side suture was performed in cases with some NAP recorded and end-to-end when NAP was absent.
Reinnervation was measured by NCS.
Results and Conclusions: Improve in CMAP at thenar muscle was achieved in all three cases. Initial reinnervation was detected at 4 months and improvement of thenar CMAP was measured with a mean rate of 2,4 mV. Clinically, patients recover some abduction function and atrophy of thenar muscles.
So, we can conclude that although indications for this nerve transfer are restricted, clinical results are successful to restore thenar abduction with no morbidity of tendon transfer. Nerve conduction studies also demonstrated improvement. Reverse end-to-side suture also reveals effectiveness of this method.
