Anterior Interosseous to Ulnar Motor Nerve Transfer – Standard

Publicado el 16/01/2014
Anterior Interosseous to Ulnar Motor Nerve Transfer
Extended Edition (130912.130911)

Injury to the ulnar nerve results in clawing of the hand due to lost of ulnar intrinsic hand muscles, lost of ulnar-innervated wrist/finger flexion, and numbness/pain within the ulnar nerve territory of the hand. To prevent clawing and reconstruct the ulnar intrinsic hand muscles, the anterior interosseous to ulnar motor nerve transfer is an available option. This involves transferring the distal pronator quadratus branch of the anterior interosseous nerve to the fascicular motor component of the ulnar nerve. This patient had an ulnar nerve injury following two ulnar nerve transpositions and reported pain and motor deficit immediately following surgery. He presented to our institution eight months post-injury and an end-to-end nerve transfer was elected due to the electrodiagnostic findings of fibrillations and no motor unit potentials by that time point. A Guyon’s canal release, flexor digitorum profundus tenodesis for grip strength, and second revision ulnar nerve transposition was performed. This video includes details on the Guyon’s canal release and anterior interosseous to ulnar motor end-to-end nerve transfer.

Table of Contents (Extended)
00:30 Orientation / Incision / Distal Exposure
01:42 Identifying Guyon’s Canal and Distal Antebrachial Fascia
03:24 Releasing Guyon’s Canal
05:38 Exposing the Tendinous Leading-edge of the Hypothenar Muscles
07:08 Releasing the Hypothenar Muscles and Deep Motor Branch of Ulnar Nerve
10:00 Proximal Exposure
12:43 Identifying the Pronator Quadratus with the Anterior Interosseous Nerve and Vessels
13:29 Dividing the Pronator Quadratus to Identify the Donor AIN Nerve Branches
17:04 Exposure of the Ulnar Nerve
18:31 Identifying the Motor Component of Ulnar Nerve and Interfascicular Dissection
19:37 Confirming (Distal) the Identification of the Motor Component of Ulnar Nerve (Proximal)
22:08 Proximal Interfascicular Dissection of the Ulnar Nerve
23:42 Dividing the Donor AIN Distal and Recipient Ulnar Motor Component Proximal
26:21 Anterior Interosseous to Ulnar Motor Nerve Transfer

Narration: Susan E. Mackinnon
Videography: Andrew Yee