Lateral Antebrachial Cutaneous Nerve as a Donor Source for Digital Nerve Grafting: A Concept Revisited

Abstract

Objective:The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries.Patients and Methods:13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis.Results:The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated.Conclusion:Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

Cutaneous nerve-conscious surgical repair of vascular access-related aneurysm assisted by anatomical ultrasonography in hemodialysis patients

“…If the trunk were transected, we recommend nerve suture or proximal nerve-end translocation to a local muscle under loupe magnification based on recommendations from orthopedic and neurosurgical articles. [9][10][11][23][24][25][26] Our study has some limitations. First, the number of enrolled patients was small.…”

“…23,24 The most important step in their prevention is to avoid intraoperative nerve injury because even minor damage to the most peripheral nerves in the digits could lead to neuropathic pain. 9,23,25 VA surgery should ensure the preservation of the SRN, LACN, and MACN trunks to avoid the risk of extensive sensory blunting and potential neuropathic pain. If the trunk were transected, we recommend nerve suture or proximal nerve-end translocation to a local muscle under loupe magnification based on recommendations from orthopedic and neurosurgical articles.…”

The Lateral Antebrachial Neurocutaneous Flap: A Cadaveric Study and Clinical Applications

“…3,4 The interconnected plexus and overlap between the LACN and the superficial radial nerve at the radial side of the distal forearm explained the result of less donor site sensory deficit; however, this was not a concern of the patients since it is a noncritical cutaneous region. 17,[29][30][31] The confusion between LABN and the radial artery perforator flap would be taken into account in the future by the cadaveric study, which separates group of limbs by excluding the LACN from the flap and thus shows differences between the LABN and the radial artery perforator flap which could be elucidated. This would actually be a completely novel study to identify differences of a neurocutaneous perforasome in the volar forearm from a purely septocutaneous perforasome.…”

Donor nerve graft assessment for covering thumb nerve defects: a cadaveric study

“…Tank et al showed that LABCN has more similarity to the fingers' nerves in the fascicle pattern [12]. Also, some clinical trials such as Schonauer et al, Pilanci et al, and Unal et al's works elucidated that more sensory regaining chance at recipient occurred by LABCN as interposed graft and encouraged by the advantage of LABCN uptake from the nonresting area of distal lateral of forearm that makes no critical problem in the patient [24][25][26]. Since Higgins et al tried to cater a nerve graft selection guideline for the middle finger, the strong point of the present study is introducing a new practical guideline for thumb nerve defects as the main finger for gripping and the importance of its function in quality of life.…”

“…Tank et al showed that LABCN has more similarity to the fingers’ nerves in the fascicle pattern [ 12 ]. Also, some clinical trials such as Schonauer et al, Pilanci et al, and Unal et al’s works elucidated that more sensory regaining chance at recipient occurred by LABCN as interposed graft and encouraged by the advantage of LABCN uptake from the non-resting area of distal lateral of forearm that makes no critical problem in the patient [ 24 – 26 ].…”