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MACKINNON - 2015 ASSH - Nerve Transfers for the Hand - Part 3 - Ulnar Nerve

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Andrew Yee

on 3 January 2016

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Transcript of MACKINNON - 2015 ASSH - Nerve Transfers for the Hand - Part 3 - Ulnar Nerve

Median Nerve
Radial Nerve
Ulnar Nerve
Radial Nerve
Median to radial transfer
FDS
to
ECRB
transfer
FCR
to
PIN
transfer
Supinator
to
PIN
transfer
MEDIAN
ULNAR
RADIAL
Pronator Teres Nerve
Brachialis
to
pronator teres
transfer
ECRB
to
pronator teres
transfer
FDS
to
pronator teres
transfer
FCR
to
pronator teres
transfer
FCU
to
pronator teres
transfer

Anterior Interosseous Nerve of Median Nerve
Brachialis
to
anterior interosseous
transfer
ECRB
to
anterior interosseous
transfer
Supinator
to
anterior interosseous
transfer
FDS
to
anterior interosseous
transfer

Flexor Pollicis Longus of Median Nerve
FDS
to
FPL
transfer

Recurrent Thenar Branch of Median Nerve
Anterior interosseous (PQ)
to
recurrent thenar
transfer with graft
Deep Motor Branch of Ulnar Nerve
Anterior interosseous (PQ)
to
ulnar motor
transfer
End-to-end (ETE)
Supercharge end-to-side (SETS)
Radial to ulnar transfer
APL / EIP
to

ulnar motor
transfer
EDQ / ECU
to
ulnar motor
transfer
MOTOR
Donor
Anterior Interosseous Nerve (PQ)
Recipient
Ulnar Motor Component
(N) ulnar motor component
(N) ulnar sensory component
(N) dorsal cutaneous branch of ulnar
Recipient
(N) dorsal cutaneous branch of ulnar
(N) anterior interosseous (PQ)
Donor
(N) ulnar motor component
(N) ulnar sensory component
Recipient
(N) anterior interosseous (PQ)
Donor
(N) 3rd webspace of median
Nerve Transfer
(N) ulnar motor component
(N) ulnar sensory component
Recipient
Recipient Proximal
FDP
Tenodesis
Guyon's Canal Release with
Deep Motor Branch
early recovery of ulnar extrinsic function
prevent possible compression inhibiting regeneration
MOTOR
SENSORY
Anterior Interosseous to Ulnar Motor Nerve Transfer
2002
2009

Surgical Technique
Post-operative Results
Adjunct Procedures
END-TO-END
Anterior Interosseous to Ulnar Motor Nerve Transfer
SUPERCHARGE END-TO-SIDE
Proximal Regenerative Front
Partial Injury Model
2nd/3rd degree injury
Axonotmesis
Supercharge in
Incomplete Model
Partial Injury - Graft
Supercharge Nerve Transfer
Transection
Supercharge in Incomplete Injury
Supercharge in Incomplete Injury
with
Donor

Transection
II.
I.
Additional Regenerative Front
Supercharge Experimental Study
Histomorphometry
End-to-end
Nerve Transfer
Supercharge
Nerve Transfer
=
Incomplete Ulnar Nerve Injury
Orientation
DONOR

- Anterior Interosseous Nerve
RECIPIENT

- Ulnar Motor Fascicle
Anterior Interosseous to Ulnar Motor
Supercharge Nerve Transfer
1-Year Post-operative
AIN
to
Ulnar Motor
SETS Nerve Transfer
Post-operative Results
RESEARCH
CLINICAL
APL / EIP to Ulnar Motor Nerve Transfer
Pre-operative Examination
Surgical Technique
Post-operative Results
Complete Median and Ulnar Nerve Injury
Proximal Radial Nerve
Distal Posterior Interosseous Nerve
DONOR
- EIP and APL/EPB
RECIPIENT
- Ulnar Motor Component
(N) ECRB
(N) PIN
(N) supinator
(N) EIP
(N) APL/EPB
(N) EPL
(N) EPL
(N) APL/EPB
(N) EIP
(N) ulnar motor
(N) ulnar sensory
(N) EIP
(N) APL/EPB
(N) ulnar motor
DONOR
DONOR
DONOR
DONOR
DONORS
RECIPIENT
RECIPIENT
Nerve Transfer
1-Year Post-operative
EIP and APL/EPB
to
Ulnar Motor
Nerve Transfer
ULNAR NERVE
1-Year Post-operative
NERVE TRANSFERS
FOR THE HAND
1991
AIN to Ulnar Motor Nerve Transfer
SURGICAL TECHNIQUE
CASE #2
ULNAR MOTOR
ANTERIOR INTEROSSEOUS
ANTERIOR INTEROSSEOUS
ULNAR MOTOR
DONOR
DISTAL
RECIPIENT
PROXIMAL
CASE #3
+ SENSORY TRANSFERS
3RD WEBSPACE
ULNAR SENSORY
RECIPIENT
DONOR
MOTOR NERVE TRANSFER
#1A
MEDIAN SENSORY
DONOR
RECIPIENT
3RD WEBSPACE
#1B
#2
DONOR
PALMAR CUTANEOUS
RECIPIENT
DORSAL CUTANEOUS
SENSORY COMPONENT
3RD WEBSPACE
ULNAR SENSORY
RECIPIENT
DONOR
ANA CROSS BRIDGE GRAFTS
27 YEAR OLD
2 YEARS POST-OPERATIVE OUTCOME
Proximal Ulnar Nerve Laceration and Primary Repair
AIN to Ulnar Motor Nerve Transfer (1 Month Post-Injury)
CASE #1 CROSS GRAFTS
CASE #2 CROSS GRAFTS
Full transcript