This paper is only available as a PDF. To read, Please Download here.
We report our experience during a 15-year period with three patients who had severe
segmental loss of more than 10 cm of both the median and ulnar nerves in the arm and
forearm. The procedure was described by St. Clair Strange and by Silverstone in 1947.
A modification of the procedure was used in our three patients. In two patients, the
proximal stumps of the median and ulnar nerves were sutured together in the proximal
forearm. The ulnar nerve was transected high in the axilla, leaving its blood supply
intact. Several months later the ulnar nerve was transposed distally, and a juncture
with the distal median nerve was created. The third patient had a significant segmental
loss in the arm of both the median and ulnar nerves. The distal stumps of the median
and ulnar nerves were sutured together, and at a later stage the ulnar nerve was transposed
proximally and sutured to the median nerve in the axilla. In all three patients, an
advancing Tinel sign was observed. Subjectively, all three patients believed there
was a definite improvement in sensibility. Objective testing was, however, less convincing.
This operation has limited applicability but definitely has a place in situations
where direct sutures or nerve grafting are impossible.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- An operation for nerve pedicle grafting. Preliminary communication..Brit J Surg. 1947; 34: 423-425
- Case report on pedicled nervegraft.Brit J Surg. 1950; 37: 331-333
- The pedicle principle in nerve grafting.Bull Am Coll Surg. 1947; 32: 226
- Ischemic nerve injury.Scand J Plast Reconstr Surg (suppl). 1970; 6: 1-113
- Structure and function of the intraneural microvessels as related to trauma, edema formation, and nerve function.J Bone Joint Surg [Am]. 1975; 57: 938-948
- Factors influencing nerve repair. I. Blood supply to peripheral nerves.Arch Surg. 1966; 93: 335-341
- Microsurgical and theoretical aspects of nerve allografting.in: Rand R Microneurosurgery. The CV Mosby Co, St Louis1978: 441-445
- Nerve grafts: The importance of an adequate blood supply.J Neurosurg. 1945; 2: 49-71
- The treatment of irreparable nerve injuries.Can Med Assoc J. 1921; 11: 833-841
- Radial-median anastomosis.J Neurosurg. 1948; 5: 562-566
Article info
Publication history
Accepted:
January 10,
1986
Received:
September 11,
1985
Identification
Copyright
© 1986 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
