gms | German Medical Science

Objectives/Interrogation: In the management of the sequelae of the brachial plexus lesions, motor and sensory recovery is sought, in order to preserve the greatest possible functionality and to reduce the complications derived from anesthetic zones, thus sensitive transfers have gained greater importance within the surgical techniques. The objective of the study is the identification of the innervation patterns of the first interdigital space, as well as to propose a surgical technique for the sensitive recovery of the radial edge of the hand in the first and second ray. For this purpose, the dissection of 20 cadaverous specimens was performed, seeking to describe the anatomical variants of the branch of the sensitive branch of the median and carry out the nerve transfer in the palm of the hand or in the distal third of the forearm.

Methods: Descriptive study, dissection in cadaveres

Results and Conclusions: Regarding the anatomical variants, it was found that the sensory branch of the median nerve branches within the carpal tunnel in 40% of the specimens, distally in 40% and proximally in 20%. With these findings, it is proposed to perform two sensitive transfers (terminal-terminal techniques): 1. of the digital nerve of the 4 finger and of the radial digital nerve of the 5 finger to the trunk of the sensory nerve of the first space or one to the common digital nerve of the thumb and the other to the radial sensory nerve of the second finger; 2. the proximal sensory transfer of the dorso-ulnar sensory branch of the ulnar nerve to the common sensory trunk for the first space, in this technique a carpal tunnel approach is necessary, since the sensory branch of the ulnar nerve is not of sufficient length as to make a distal transfer to this and therefore it is necessary to identify the receiver trunk distal to the tunnel and dissect it to the distal forearm to perform the transfer. This last technique would require a greater surgical exposure, greater dissection and manipulation of the receptor nerve without improving the expected results, for which reason the transfer at the level of the palm of the hand is recommended.