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Functional Restoration Following High level Injuries of Upper Extremity Including Both Median and Ulnar Nerve
Fatih Zor, MD1; Ismail Safaz, MD2; Umit H. Ulas, MD3; Serdar Ozturk, MD1
1Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, College of Medicine, Ankara, Turkey; 2Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, College of Medicine, Ankara, Turkey; 3Neurology, Gulhane Military Medical Academy, College of Medicine, Ankara, Turkey
Aim: High level injuries of upper extremity including both median and ulnar nerve are challenging. Repair of high level nerve injuries have suboptimal results despite meticulous surgical technique. As a result, new surgical options are being searched for better outcomes. In this study, we present 4 cases of median and ulnar nerve injuries due to gunshot wounds which were treated successfully with nerve transfers.
Patients and Method: The study is performed in Gulhane Military Medical Academy. Four patients suffering from both median and ulnar nerve injuries due to gunshot wounds were included in the study. The ulnar nerve motor function is restored by a nerve transfer from extensor carpi ulnaris branch of radial nerve. Anterior interosseous nerve function and pronator teres function were restored nerve transfers from brachialis branch of musculocutaneous nerve and extensor carpi radialis branch of radial nerve, respectively. Opponens pollicis function is restored by nerve transfer from extensor digiti quinti branch of radial nerve. The functional outcome is evaluated with EMG, lateral pinch and pulp pinch strength, grip strength and Jebsen hand function test.
Results: EGM evaluation revealed a functional nerve coaptation in all patients. When compared with the preoperative measurements, lateral pinch, pulp pinch, grip strength and Jebsen hand function test results showed a marked increase in the postoperative period. 
*Data indicates the percentage of hand function of injured hand according to the uninjured hand during the preoperative and postoperative period. Expecially, functional results of patients with both median and ulnar nerve injury was found to be encouraging.
Conclusion: Nerve transfers provide a new option for reconstruction of high nerve injuries of forearm. Expecially, it remains the only option for patients with median and ulnar nerve injury.
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