Abstract
Background
The traditional surgical approach to repair of brachial plexus lesions involves use of whole segment ulnar nerve graft for contralateral seventh cervical (cC7) nerve root transfer, which sabotages the possibility of ulnar nerve recovery. We assessed the anatomical feasibility of a new approach that involves preservation of the motor branch of ulnar nerve (MBUN), for a later stage repair using the recovered pronator quadratus motor branch (PQMB), subsequent to the cC7 transfer procedure.
Methods
Twenty-seven adult cadaver arms and one side of fresh adult cadaver were used in this study. The anterior interosseous nerve and its PQMB, as well as the motor and sensory branches of the ulnar nerve were dissected. The distances from the end of PQMB to the mid-point of a line joining the radial styloid and ulnar styloid, as well as to the point of divergence of the ulnar nerve, were measured. The MBUN was dissected from distal to proximal and the maximum length was measured. The diameter and number of axons of the nerve branches were also recorded.
Results
The distance from the end of the PQMB to the midpoint of the radial styloid and ulnar styloid was 6.04 ± 0.52 cm, and that to the point of divergence of the ulnar nerve was 8.02 ± 0.63 cm. The maximum length of the MBUN after its dissociation was 9.70 ± 1.38 cm. The mean diameters of axons of the MBUN and PQMB were 0.09 ± 0.02 cm and 0.05 ± 0.01 cm, respectively. The corresponding mean numbers of axons were 2913 ± 624 and 757 ± 183, respectively.
Conclusions
The results indicate that the PQMB is suitable for transferring to the MBUN without nerve graft. This anatomical study paves the way for further testing of this new procedure after cC7 transfer in clinical settings.
Similar content being viewed by others
References
Boutros S, Nath RK, Yuksel E, Weinfeld AB, Mackinnon SE (1999) Transfer of flexor carpi ulnaris branch of the ulnar nerve to the pronator teres nerve: histomorphometric analysis. J Reconstr Microsurg 15:119–122
Brown JM, Yee A, Mackinnon SE (2009) Distal median to ulnar nerve transfers to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery 65:966–977, discussion 977-968
Chen L, Gu YD, Hu SN, Xu JG, Xu L, Fu Y (2007) Contralateral C7 transfer for the treatment of brachial plexus root avulsions in children—a report of 12 cases. J Hand Surg [Am] 32:96–103
Dubuisson AS, Kline DG (2002) Brachial plexus injury: a survey of 100 consecutive cases from a single service. Neurosurgery 51:673–682, discussion 682-673
Flores LP (2011) Distal anterior interosseous nerve transfer to the deep ulnar nerve and end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve for treatment of high ulnar nerve injuries: experience in five cases. Arq Neuropsiquiatr 69:519–524
Friedman AH, Nunley JA 2nd, Goldner RD, Oakes WJ, Goldner JL, Urbaniak JR (1990) Nerve transposition for the restoration of elbow flexion following brachial plexus avulsion injuries. J Neurosurg 72:59–64
Gu YD, Cai PQ, Xu F, Peng F, Chen L (2003) Clinical application of ipsilateral C7 nerve root transfer for treatment of C5 and C6 avulsion of brachial plexus. Microsurgery 23:105–108
Gu YD, Zhang GM, Chen DS, Yan JG, Cheng XM, Chen L (1992) Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion. J Hand Surg (Br) 17:518–521
Haase SC, Chung KC (2002) Anterior interosseous nerve transfer to the motor branch of the ulnar nerve for high ulnar nerve injuries. Ann Plast Surg 49:285–290
Jiang BG, Yin XF, Zhang DY, Fu ZG, Zhang HB (2007) Maximum number of collaterals developed by one axon during peripheral nerve regeneration and the influence of that number on reinnervation effects. Eur Neurol 58:12–20
Lutz BS, Chuang DC, Chuang SS, Hsu JC, Ma SF, Wei FC (2000) Nerve transfer to the median nerve using parts of the ulnar and radial nerves in the rabbit—effects on motor recovery of the median nerve and donor nerve morbidity. J Hand Surg (Br) 25:329–335
McGuiness CN, Kay SP (2002) The prespinal route in contralateral C7 nerve root transfer for brachial plexus avulsion injuries. J Hand Surg (Br) 27:159–160
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 18:459–464
Rodriguez A, Chuang DC, Chen KT, Chen RF, Lyu RK, Ko YS (2011) Comparative study of single-, double-, and triple-nerve transfer to a common target: experimental study of rat brachial plexus. Plast Reconstr Surg 127:1155–1162
Schenck TL, Stewart J, Lin S, Aichler M, Machens HG, Giunta RE (2015) Anatomical and histomorphometric observations on the transfer of the anterior interosseous nerve to the deep branch of the ulnar nerve. J Hand Surg Eur 40:591–596
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-A:549–552
Wang Y, Zhu S (1997) Transfer of a branch of the anterior interosseus nerve to the motor branch of the median nerve and ulnar nerve. Chin Med J (Engl) 110:216–219
Xu JG, Gu YD, Hu SN, Wang H, Chen L (2004) Electrophysiologic study of influence on C7 innervated muscles after transection of different C7 fascicles. Microsurgery 24:147–150
Xu JG, Wang H, Hu SN, Gu YD (2004) Selective transfer of the C7 nerve root: an experimental study. J Reconstr Microsurg 20:463–470, discussion 471-462
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
Huashan Hospital, Fudan University provided financial support in the form of Scientific Research project (Grand No. 2013QD02). The National Natural Science Foundational of China provided financial support in the form of National Natural Science Fund of China (Grand No. 81572127). The sponsor had no role in the design or conduct of this research.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Comment
This article demonstrates the anatomical feasibility of performing distal neurotization of the motor branch of the ulnar nerve with a distal median nerve branch to the pronator quadratus muscle. Although surgically feasible, as the authors point out only future clinical trials will demonstrate whether this procedure has any clinical benefit, especially in the setting of a severe brachial plexus injury treated with a contralateral C7 here transfer mediated by an ulnar nerve graft.
Michel Kliot
Illinois, USA
Rights and permissions
About this article
Cite this article
Rui, J., Zhou, Y., Wang, L. et al. Restoration of ulnar nerve motor function by pronator quadratus motor branch: an anatomical study. Acta Neurochir 158, 755–759 (2016). https://doi.org/10.1007/s00701-016-2728-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-016-2728-1