Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature reinnervation

John Barbour, Andrew Yee, Lorna C. Kahn, Susan E. MacKinnon

Research output: Contribution to journalArticlepeer-review

123 Scopus citations

Abstract

Functional motor recovery after peripheral nerve injury is predominantly determined by the time to motor end plate reinnervation and the absolute number of regenerated motor axons that reach target. Experimental models have shown that axonal regeneration occurs across a supercharged end-to-side (SETS) nerve coaptation. In patients with a recovering proximal ulnar nerve injury, a SETS nerve transfer conceptually is useful to protect and preserve distal motor end plates until the native axons fully regenerate. In addition, for nerve injuries in which incomplete regeneration is anticipated, a SETS nerve transfer may be useful to augment the regenerating nerve with additional axons and to more quickly reinnervate target muscle. We describe our technique for a SETS nerve transfer of the terminal anterior interosseous nerve (AIN) to the pronator quadratus muscle (PQ) end-to-side to the deep motor fascicle of the ulnar nerve in the distal forearm. In addition, we describe our postoperative therapy regimen for these transfers and an evaluation tool for monitoring progressive muscle reinnervation. Although the AIN-to-ulnar motor group SETS nerve transfer was specifically designed for ulnar nerve injuries, we believe that the SETS procedure might have broad clinical utility for second- and third-degree axonotmetic nerve injuries, to augment partial recovery and/or "babysit" motor end plates until the native parent axons regenerate to target. We would consider all donor nerves currently utilized in end-to-end nerve transfers for neurotmetic injuries as candidates for this SETS technique.

Original languageEnglish
Pages (from-to)2150-2159
Number of pages10
JournalJournal of Hand Surgery
Volume37
Issue number10
DOIs
StatePublished - Oct 2012

Keywords

  • Intrinsic ulnar neuropathy
  • nerve transfer
  • supercharge end-to-side

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