Ulnar Index of Median to Ulnar Ring of Ulnar Sensory Nerve Transfer and Prevention of Proximal Neuroma 1 Fox IK1 Yee A1 August 20, 2011Disclosure: No authors have a financial interest in any of the products, devices, or drugs mentioned in this production or publication.For distal sensory ulnar nerve injuries in the hand, there is an alternative approach in restoration of critical ulnar nerve sensation. In this case, the patient had a gunshot wound and required amputation of the small finger. As result, the ulnar aspect of the ring finger became the critical target for sensory reinnervation. In addition, soft tissue coverage of the palm was an obstacle for long nerve grafts. Goals were to restore critical sensation and prevent painful neuroma formation. The median nerve branch to the ulnar aspect of the index finger was used as the donor nerve to reinnervate the recipient ulnar nerve branch to the ulnar aspect of the ring finger. A nerve graft was required to bridge the distance and the ulnar sensory fascicle proximal to the injury was harvested as expendable graft material. An acellularized nerve allograft is used to extend the proximal end of the ulnar sensory fascicle for proximal transposition. To preserve rudimentary sensation to the donor nerve, an end-to-side nerve transfer to the lateral aspect of the long finger is completed.Keywords: proximal transpositionnerve graftingneuroma preventionacellularized nerve allograftAxogen Avance Nerve Graftulnar nervesensory reconstructionsensory nerve transfernerve injury You must login to view the full article and extended video on this page. Standard Edition Table of Contents- Slow down- Frustration00:00:00 - Introduction00:00:10 - Orientation and Overview of Surgical Management00:01:01 - Incision and Exposure of Ulnar Nerve Proximal to Area of Injury00:01:29 - Identification of the Ulnar Nerve and Dorsal Cutaneous Branch of Ulnar Nerve00:01:48 - Electrical Stimulation of the Ulnar Nerve00:02:05 - Incision and Exposure of Recipient Ulnar Nerve to Ulnar Aspect of Ring Finger00:02:32 - Identification of the Recipient Ulnar Nerve to Ulnar Aspect of Ring Finger00:03:22 - Identification of the Donor Median Nerve to Ulnar Aspect of Index Finger00:03:59 - Further Exposure of Proximal Ulnar Nerve for Graft Harvest00:04:33 - Intrafascicular Neurolysis of Proximal Ulnar Nerve00:05:10 - Autologous Graft Harvest of Expendable Sensory Component of the Ulnar Nerve00:05:54 - Acellularized Nerve Allograft (ANA) Extender for Proximal Transposition00:06:46 - Donor Ulnar Aspect of Index to Autologous Graft Nerve Repair00:08:16 - End-to-side Sensory Nerve Transfer of Radial Long to Ulnar Index Finger00:08:54 - Autologous Graft to Recipient Ulnar Aspect of Ring Nerve Repair00:09:41 - Intermuscular Proximal Transposition of Ulnar Sensory Component Using ANA Extender You must login to view the full article and extended video on this page. Leave a Comment Cancel replyYou must be logged in to post a comment.