Comparison of Ulnar Intrinsic Function following Supercharge End-to-Side Anterior Interosseous–to–Ulnar Motor Nerve Transfer: A Matched Cohort Study of Proximal Ulnar Nerve Injury Patients

Baltzer, Heather; Woo, Alice; Oh, Christine; Moran, Steven L.

doi:10.1097/prs.0000000000002747

Cited by 81 publications

(75 citation statements)

References 25 publications

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“…This suggests that both the immediate side-to-side repair and the delayed proximal end-to-end repair have influence on the functional outcome, and thus, both repair procedures are worth performing. The results are in accordance with the previous so-called baby-sitting techniques [3, 4, 7, 8, 12, 16–18, 31, 32]. …”

Section: Discussionsupporting

confidence: 91%

Protective distal side-to-side neurorrhaphy in proximal nerve injury—an experimental study with rats

et al. 2019

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BackgroundSide-to-side neurorrhaphy may protect the denervated end organ and preserve the initial connection with proximal stump. We examined the effect of protective side-to-side anastomosis on nerve and end organ regeneration in proximal nerve injury model.MethodsThe left common peroneal nerve of 24 Sprague Dawley rats was proximally transected. In groups B and C, side-to-side neurorrhaphy was performed distally between the peroneal and tibial nerves without (group B) and with (group C) partial donor nerve axotomy inside the epineural window. Group A served as an unprotected control. After 26 weeks, the proximal transection was repaired with end-to-end neurorrhaphy on all animals. Regeneration was followed during 12 weeks with the walk track analysis. Morphometric studies and wet muscle mass calculations were conducted at the end of the follow-up period.ResultsThe results of the walk track analysis were significantly better in groups B and C compared to group A. Groups B and C showed significantly higher wet mass ratios of the tibialis anterior and extensor digitorum longus muscle compared to group A. Group C showed significantly higher morphometric values compared to group A. Group B reached higher values of the fibre count, fibre density, and percentage of the fibre area compared to group A.ConclusionsProtective distal side-to-side neurorrhaphy reduced muscle atrophy and had an improving effect on the morphometric studies and walk track analysis. Distal side-to-side neurorrhaphy does not prevent the regenerating axons to grow from the proximal stump to achieve distal nerve stump.

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Section: Discussionsupporting

confidence: 91%

Protective distal side-to-side neurorrhaphy in proximal nerve injury—an experimental study with rats

et al. 2019

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“…Moreover, a few clinical papers have shown promising results of using SETS transfer for enhancing intrinsic hand muscle function in proximal ulnar nerve injuries, yet the level of evidence is still weak. 4,7 In light of the current literature, no proven surgical options for the treatment of severe NIC exist, for which SETS may be even more applicable. This prompted us to assess the utility of SETS in an NIC experimental model 2,3 in a way that emulates a clinical scenario.…”

mentioning

confidence: 99%

Testing the effectiveness and the contribution of experimental supercharge (reversed) end-to-side nerve transfer

Nadi¹,

Ramachandran²,

Islam³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Supercharge end-to-side (SETS) transfer, also referred to as reverse end-to-side transfer, distal to severe nerve compression neuropathy or in-continuity nerve injury is gaining clinical popularity despite questions about its effectiveness. Here, the authors examined SETS distal to experimental neuroma in-continuity (NIC) injuries for efficacy in enhancing neuronal regeneration and functional outcome, and, for the first time, they definitively evaluated the degree of contribution of the native and donor motor neuron pools. METHODS This study was conducted in 2 phases. In phase I, rats (n = 35) were assigned to one of 5 groups for unilateral sciatic nerve surgeries: group 1, tibial NIC with distal peroneal-tibial SETS; group 2, tibial NIC without SETS; group 3, intact tibial and severed peroneal nerves; group 4, tibial transection with SETS; and group 5, severed tibial and peroneal nerves. Recovery was evaluated biweekly using electrophysiology and locomotion tasks. At the phase I end point, after retrograde labeling, the spinal cords were analyzed to assess the degree of neuronal regeneration. In phase II, 20 new animals underwent primary retrograde labeling of the tibial nerve, following which they were assigned to one of the following 3 groups: group 1, group 2, and group 4. Then, secondary retrograde labeling from the tibial nerve was performed at the study end point to quantify the native versus donor regenerated neuronal pool. RESULTS In phase I studies, a significantly increased neuronal regeneration in group 1 (SETS) compared with all other groups was observed, but with modest (nonsignificant) improvement in electrophysiological and behavioral outcomes. In phase II experiments, the authors discovered that secondary labeling in group 1 was predominantly contributed from the donor (peroneal) pool. Double-labeling counts were dramatically higher in group 2 than in group 1, suggestive of hampered regeneration from the native tibial motor neuron pool across the NIC segment in the presence of SETS. CONCLUSIONS SETS is indeed an effective strategy to enhance axonal regeneration, which is mainly contributed by the donor neuronal pool. Moreover, the presence of a distal SETS coaptation appears to negatively influence neuronal regeneration across the NIC segment. The clinical significance is that SETS should only employ synergistic donors, as the use of antagonistic donors can downgrade recovery.

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“…10 The intrinsic muscles can be innervated by the pronator quadratus muscle branch in the early stage and are expected to receive innervation from the regenerated ulnar nerve itself in the later stage. 31 According to the follow-up data, the degree of sensory recovery was found in the ulnar nerve-innervated area can reach the S2 level or higher, suggesting that some regenerated nerve fibres indeed reach the distal effector after repair of the injured part of the ulnar nerve, even though the regeneration path is long. Therefore, end-to-side anastomosis can achieve an additive effect due to ulnar nerve regeneration.…”

Section: Discussionmentioning

confidence: 93%

<p>Repair Method for Complete High Ulnar Nerve Injury Based on Nerve Magnified Regeneration</p>

Ding

Pan

et al. 2020

TCRM

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These authors contributed equally to this workPurpose: Complete high ulnar nerve injury can cause serious sequelae, including residual sensation and loss of movement and especially dysfunction of the intrinsic muscles of the hand. As a solution to treat complete high ulnar nerve injury, we proposed a new repair method for ulnar nerve injury based on nerve-magnified regeneration. Methods: Twenty-two patients with complete division of the ulnar nerve at a high level who were treated from May 2013 to December 2016 were divided into two groups. The proposed repair method for complete high ulnar nerve injury was performed in group I (11 patients), while the traditional repair method, ie, repair of the original injury site of the ulnar nerve, was used in group II (11 patients). Results: The results showed no significant difference in the mean sensory scores assigned by the Highet-Zachary scheme (the Highet Scale) between the two groups. The mean Highet Scale score of muscle strength for the first dorsal interosseus muscle was significantly better in group I than that in group II (p=0.010). In group I, 10 of 11 patients were graded as M4 or M5. Grip strength, pinch strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were significantly better in group I than those in group II (p<0.01). Conclusion: Therefore, this method for complete high ulnar nerve injury based on nervemagnified regeneration can shorten the path of motor nerve regeneration, effectively reduce atrophy of the intrinsic muscles of the hand, and provide better hand function.

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Comparison of Ulnar Intrinsic Function following Supercharge End-to-Side Anterior Interosseous–to–Ulnar Motor Nerve Transfer: A Matched Cohort Study of Proximal Ulnar Nerve Injury Patients

Abstract: Therapeutic, III.

Cited by 81 publications

References 25 publications

Protective distal side-to-side neurorrhaphy in proximal nerve injury—an experimental study with rats

Protective distal side-to-side neurorrhaphy in proximal nerve injury—an experimental study with rats

Testing the effectiveness and the contribution of experimental supercharge (reversed) end-to-side nerve transfer

<p>Repair Method for Complete High Ulnar Nerve Injury Based on Nerve Magnified Regeneration</p>

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