Journal of Hand and Microsurgery

, Volume 7, Issue 1, pp 173–176 | Cite as

Management of Iatrogenic Ulnar Nerve Transection

  • Mark HenryEmail author
Case Report


A case of iatrogenic ulnar nerve laceration at the elbow is presented. Five subsequent surgeries over the course of the ensuing 20 months were performed to address this complication. The article examines the scientific basis for the various decisions needed to formulate a strategy that effectively addresses the problem. Emphasis is placed on the microsurgery of nerve topics: direct nerve repair, autogenous cable nerve grafting, biodegradable conduits, decellularized nerve allograft, and transfer of the anterior interosseous nerve to the ulnar motor branch. The discussion covers the relationship between choices made at the level of the original injury at the cubital tunnel to the timing and selection of distal reconstructive efforts, with specific attention to the distinction between end-to-end anterior interosseous to ulnar motor branch transfer as opposed to the supercharged end-to-side variation of this procedure.


Grafting Laceration Nerve Release Ulnar 


  1. 1.
    Kim DH, Han K, Tiel RL, Murovic JA, Kline DG (2003) Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg 98(5):993–1004PubMedCrossRefGoogle Scholar
  2. 2.
    Murovic JA (2009) Upper-extremity peripheral nerve injuries: a Louisiana state university health sciences center literature review with comparison of the operative outcomes of 1837 Louisiana state university health sciences center median, radial, and ulnar nerve lesions. Neurosurgery 65:A11–17PubMedCrossRefGoogle Scholar
  3. 3.
    Karabeg R, Jakirlic M, Dujso V, Obradovic G, Arslanagic S (2013) Outcomes of ulnar nerve grafting. Med Arh 67(1):39–41CrossRefGoogle Scholar
  4. 4.
    Vastamaki M, Kallio PK, Solonen KA (1993) The results of secondary microsurgical repair of ulnar nerve injury. J Hand Surg (Br) 18(3):323–326CrossRefGoogle Scholar
  5. 5.
    Terzis JK, Kokkalis ZT (2008) Outcomes of secondary reconstruction of ulnar nerve lesions: our experience. Plast Reconstr Surg 122(4):1100–1110PubMedCrossRefGoogle Scholar
  6. 6.
    Yang M, Rawson JL, Zhang EW, Arnold PB, Lineaweaver W, Zhang F (2011) Comparisons of outcomes from repair of median nerve and ulnar nerve defect with nerve graft and tubulization: a meta-analysis. J Reconstr Microsurg 27(8):451–460PubMedCrossRefGoogle Scholar
  7. 7.
    Konofaos P, Ver Halen JP (2013) Nerve repair by means of tubulization: past, present, future. J Reconstr Microsurg 29(3):149–164PubMedCrossRefGoogle Scholar
  8. 8.
    Wangensteen KJ, Kalliainen LK (2010) Collagen tube conduits in peripheral nerve repair: a retrospective analysis. HAND 5(3):273–277PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Dienstknecht T, Klein S, Vykoukal J, Gehmert S, Koller M, Gosau M, Prantl L (2013) Type I collagen nerve conduits for median nerve repairs in the forearm. J Hand Surg [Am] 38(6):1119–1124CrossRefGoogle Scholar
  10. 10.
    Giusti G, Willems WF, Kremer T, Friedrich PF, Bishop AT, Shin AY (2012) Return of motor function after segmental nerve loss in a rat model: comparison of autogenous nerve graft, collagen conduit, and processed allograft (Axogen). J Bone Joint Surg Am 94(5):410–417PubMedCrossRefGoogle Scholar
  11. 11.
    Moore AM, Kasukurthi R, Magill CK, Farhadi HF, Borschel GH, Mackinnon SE (2009) Limitations of conduits in peripheral nerve repairs. HAND 4(2):180–186PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Whitlock EL, Tuffaha SH, Luciano JP, Yan Y, Hunter DA, Magill CK, Moore AM, Mackinnon SE, Borschel GH (2009) Processed allografts and type I collagen conduits for repair of peripheral nerve gaps. Muscle Nerve 39(6):787–799PubMedCrossRefGoogle Scholar
  13. 13.
    Berrocal YA, Almeida VW, Levi AD (2013) Limitations of nerve repair of segmental defects using acellular conduits. J Neurosurg 119(3):733–738PubMedCrossRefGoogle Scholar
  14. 14.
    Brooks DN, Weber RV, Chao JD, Rinker BD, Zoldos J, Robichaux MR, Ruggeri SB, Anderson KA, Bonatz EE, Wisotsky SM, Cho MS, Wilson C, Cooper EO, Ingari JV, Safa B, Parrett BM, Buncke GM (2012) Processed nerve allografts for peripheral nerve reconstruction: a multicenter study of utilization and outcomes in sensory, mixed and motor nerve reconstructions. Microsurgery 32(1):1–14PubMedCrossRefGoogle Scholar
  15. 15.
    Moore AM, MacEwan M, Santosa KB, Chenard KE, Ray WZ, Hunter DA (2011) Acellular nerve allografts in peripheral nerve regeneration: a comparative study. Muscle Nerve 44:221–234PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Chiriac S, Facca S, Diaconu M, Gouzou S, Liverneaux P (2012) Experience of using the bioresorbable copolyester poly (DL-lactide-E-caprolactone) nerve conduit guide NeurolacTM for nerve repair in peripheral nerve defects: report on a series of 28 lesions. J Hand Surg Eu 37(4):342–349CrossRefGoogle Scholar
  17. 17.
    Cho MS, Rinker BD, Weber RV, Chao JD, Ingari JV, Brooks D, Buncke GM (2012) Functional outcome following nerve repair in the upper extremity using processed nerve allograft. J Hand Surg [Am] 37(11):2340–2349CrossRefGoogle Scholar
  18. 18.
    Barbour J, Yee A, Kahn LC, Mackinnon SE (2012) Supercharged end-to-side anterior interosseous to ulnar motor nerve transfer for intrinsic musculature re innervation. J Hand Surg [Am] 37(10):2150–2159CrossRefGoogle Scholar
  19. 19.
    Novak CB, Mackinnon SE (2002) Distal anterior interosseous nerve transfer to the deep motor branch of the ulnar nerve for reconstruction of high ulnar nerve injuries. J Reconstr Microsurg 18:459–464PubMedCrossRefGoogle Scholar
  20. 20.
    Ustun ME, Ogun TC, Buyukmumcu M, Salbacak A (2001) Selective restoration of motor function in the ulnar nerve by transfer of the anterior interosseous nerve. An anatomical feasibility study. J Bone Joint Surg Am 83(4):549–552PubMedGoogle Scholar
  21. 21.
    Wolfe SW, Lee SK (2012) Nerve transfers for the upper extremity: new horizons in nerve reconstruction. J Am Acad Orthop Surg 20(8):506–517PubMedCrossRefGoogle Scholar
  22. 22.
    Sahin F, Atalay NS, Akkaya N, Ercidogan O, Basakci B, Kuran B (2014) The correlation of neurophysiological findings with clinical and functional status in patients following traumatic nerve injury. J Hand Surg Eu 39(2):199–206CrossRefGoogle Scholar

Copyright information

© Society of the Hand & Microsurgeons of India 2014

Authors and Affiliations

  1. 1.Hand and Wrist Center of HoustonHoustonUSA

Personalised recommendations