Supercharge End-to-Side Nerve Transfer: Systematic Review

Abstract

Background: To decrease the time to reinnervation of the intrinsic motor end plates after high ulnar nerve injuries, a supercharged end-to-side (SETS) anterior interosseous to ulnar motor nerve transfer has been proposed. The purpose of this study was to compile and review the indications, outcomes, and complications of SETS anterior interosseous to ulnar motor nerve transfer. Methods: A literature search was performed, identifying 73 papers; 4 of which met inclusion and exclusion criteria, including 78 patients. Papers included were those that contained the results of SETS between the years 2000 and 2018. Data were pooled and analyzed focusing on the primary outcomes: intrinsic muscle recovery and complications. Results: Four studies with 78 patients met inclusion and exclusion criteria. Most patients (33.3%) underwent SETS for an ulnar nerve lesion in continuity, the average age was 46.5 years, and the average follow-up was 10 months. The average duration of symptoms before surgery was 99 weeks, all patients had weakness and numbness, nearly all (96%) had atrophy, and half (53%) had pain. Grip and key pinch strength improved 202% and 179%, respectively, from the preoperative assessment. The vast majority (91.9%) recovered intrinsic function at an average of 3.7 months. Other than 8% of patients who did not recover intrinsic strength, no other complications were reported in any of the 78 patients. Conclusions: The SETS is a successful procedure with low morbidity, which may restore intrinsic function in patients with proximal nerve injuries.

An interesting case of spindle cell sarcoma of elbow

“…12 A meta-analysis by Dunn et al showed that ETS yielded a high return of intrinsic function in 91.9% patients at 3.7 months and 8% did not recover intrinsic strength. 10 Our patient had no functional deficit on review at 3 months. The ETS anterior interosseous-to-ulnar nerve transfer may be a useful technique for augmenting intrinsic muscle function for severe, in continuity lesions of the ulnar nerve where limited surgical options exist.…”

“…9 Wide local excision of the tumour is the treatment of choice followed by thorough biopsy and additional excision if necessary. 10 In high grade lesions, prognosis is grim and chemotherapy and radiation are the only methods of controlling the cancer. 4 Functional compromise that can occur while giving adequate clearance margin for the tumor is common, however microsurgical techniques and neuroanastomosis provide the patient with better prognosis along with preserving function.…”

Letter to the Editor Regarding: “Supercharge End-to-Side Nerve Transfer: A Systematic Review,” by Dunn et al.

“…After analysis of the 78 patients from the 4 studies, they concluded that the supercharge end-to-side transfer (SETS) of the anterior interosseous nerve (AIN) to the motor branch of the ulnar nerve (MUN) had yielded a high return of intrinsic function of 91.7 % at an average of 3.7 months. 1 These results must be interpreted with caution. Such a rapid and complete recovery is typical of incomplete lesions or aberrant median-to-ulnar intrinsic innervation.…”

“…The patients included have a mixed etiology of compressive, inflammatory, and traumatic lesions of the ulnar nerve, as well as a variety of adjunctive procedures. [1][2][3][4] This would make interpretation of the results difficult, and we feel that traumatic lesions should be a separate subgroup from compressive lesions. A further concern is that 2 of the 4 papers included in the systematic review were not papers about SETS transfers, but used a standard end-to-end (ETE) transfer technique.…”

“…To the editor, We read with interest the recent article entitled "Supercharge End-to-Side Nerve Transfer: A Systematic Review" by Dunn et al 1 They evaluated 73 papers, eventually including 4 papers. After analysis of the 78 patients from the 4 studies, they concluded that the supercharge end-to-side transfer (SETS) of the anterior interosseous nerve (AIN) to the motor branch of the ulnar nerve (MUN) had yielded a high return of intrinsic function of 91.7 % at an average of 3.7 months.…”