Complete Recovery of an Ulnar Nerve Transection using Processed Nerve Allograft in the Setting of a Pregnant Patient: Does Prolactin Play a Roll?
Michael T. Friel, MD, FACS, FAAP1; Joseph Ogrodnik, MD2
1Ochsner Hospital for Children, New Orleans, LA; 2University of Mississippi Medical Center, Jackson, MS
Background: Processed nerve allografts have been shown to be safe and effective for reconstruction of peripheral nerves in the upper extremity [1][2]. To the best of our knowledge there is no published data for management of a traumatic injury to a peripheral nerve in the setting of a pregnant patient. There have been numerous reports of multiple sclerosis going into remission during pregnancy[3], suggesting a hormonal connection to nerve regeneration. This has been attributed to the hormone prolactin, which has been shown to have important neuroprotective and remyelinating properties[4].
Case Report: We present a case of a woman who sustained a deep laceration to her volar distal forearm. At the time of her injury, she was 9-weeks pregnant. She sustained complete transections of several flexor tendons, the ulnar nerve proximal to the wrist, and the ulnar artery. She underwent operative exploration under axillary nerve block. After debridement, there was a 20 mm gap in the ulnar nerve. This was repaired using a cadaveric allograft followed by a nerve wrap. The tendons were repaired in the usual fashion. She recovered uneventfully and participated well with occupational therapy. She went on to deliver a healthy baby. At 10 months post-op, she had regained S3 sensation and M4 motor function. She has recovered full use of her hand and has returned to work as a typist.
Conclusion: To our knowledge, there are no other published cases of such a remarkable recovery after complete ulnar nerve transection in the setting of pregnancy. While the effect of prolactin on the central nervous system has been studied, there are no studies showing the effect of prolactin on peripheral nerve injuries. Perhaps this could open up treatment options or adjunct therapies in the future for patients with peripheral nerve injuries. Prolactin is not without its own side-effects, and it is our hope that this case could lead to the development of animal studies to further characterize the effect of prolactin, or other maternal hormones, on the effects of peripheral nerve healing.
[1] Microsurgery. 2012 Jan;32(1):1-14. doi: 10.1002/micr.20975. Epub 2011 Nov 28.
[2] J Hand Surg Am. 2012 Nov;37(11):2340-9. doi: 10.1016/j.jhsa.2012.08.028.
[3] Mult Scler. 2013 Jan;19(1):15-23. doi: 10.1177/1352458512458555. Epub 2012 Aug 29.
[4] Int J Mol Sci. 2016 Dec 2;17(12). doi: 10.3390/ijms17122026. 2 December 2016
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