Proximal or middle lesions of the ulnar or median nerves are responsible for extensive loss of hand motor function.This occurs even when the most meticulous microsurgical techniques or nerve grafts are used.Previous s...Proximal or middle lesions of the ulnar or median nerves are responsible for extensive loss of hand motor function.This occurs even when the most meticulous microsurgical techniques or nerve grafts are used.Previous studies had proposed that nerve transfer was more effective than nerve grafting for nerve repair.Our hypothesis is that transfer of the posterior interosseous nerve,which contains mainly motor fibers,to the ulnar or median nerve can innervate the intrinsic muscles of hands.The present study sought to investigate the feasibility of reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve by transferring the extensor indicis proprius branch of the posterior interosseous nerve obtained from adult cadavers.The results suggested that the extensor indicis proprius branch of the posterior interosseous nerve had approximately similar diameters and number of fascicles and myelinated nerve fibers to those of the deep branch of ulnar nerve and the thenar branch of the median nerve.These confirm the feasibility of extensor indicis proprius branch of posterior interosseous nerve transfer for reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve.This procedure could be a novel and effective method for the functional recovery of the intrinsic muscles of hands after ulnar nerve or median nerve injury.展开更多
BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anat...BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum,where tendon harvest is often performed,and share our preferred technique for EIP to EPL transfer.METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected.Tendon circumference and relationship of the EIP and extensor digitorum communis to the index(EDCI)at the metacarpophalangeal(MCP)joint and the distal extensor retinaculum were recorded.Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.RESULTS EIP was ulnar to the EDCI in 96.5%of specimens(28/29)at the distal edge of the extensor retinaculum.In the remaining specimen,EIP was volar to EDCI.Tendon circumference at the distal extensor retinaculum averaged(9.3 mm±1.7 mm)for EDCI and 11.1 mm(±2.7 mm)for EIP(P=0.0010).The tendon circumference at the index MCP joint averaged 11.0 mm(±1.7 mm)for EDCI and 10.6 mm(±2.1 mm)for EIP(P=0.33).EIP had a greater circumference in 76%(22/29)of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31%(9/29)of specimens at the MCP joint.CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum,which can be taken into consideration for tendon transfers involving EIP.展开更多
基金supported by grants from the General Program of Health Department of Jiangsu Province in China,No.H201414the Science and Technology Development and Planning Program of Suzhou City in China,No.SYS201468+2 种基金the Science and Technology and Planning Program of Suzhou City in China,No.SS201636the Second Affiliated Hospital of Soochow University Preponderant Clinic Discipline Group Project in China,No.XKQ2015010the Science Pre-Research Project of the Second Affiliated Hospital of Soochow University in China,No.SDFEYQN1403
文摘Proximal or middle lesions of the ulnar or median nerves are responsible for extensive loss of hand motor function.This occurs even when the most meticulous microsurgical techniques or nerve grafts are used.Previous studies had proposed that nerve transfer was more effective than nerve grafting for nerve repair.Our hypothesis is that transfer of the posterior interosseous nerve,which contains mainly motor fibers,to the ulnar or median nerve can innervate the intrinsic muscles of hands.The present study sought to investigate the feasibility of reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve by transferring the extensor indicis proprius branch of the posterior interosseous nerve obtained from adult cadavers.The results suggested that the extensor indicis proprius branch of the posterior interosseous nerve had approximately similar diameters and number of fascicles and myelinated nerve fibers to those of the deep branch of ulnar nerve and the thenar branch of the median nerve.These confirm the feasibility of extensor indicis proprius branch of posterior interosseous nerve transfer for reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve.This procedure could be a novel and effective method for the functional recovery of the intrinsic muscles of hands after ulnar nerve or median nerve injury.
文摘BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum,where tendon harvest is often performed,and share our preferred technique for EIP to EPL transfer.METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected.Tendon circumference and relationship of the EIP and extensor digitorum communis to the index(EDCI)at the metacarpophalangeal(MCP)joint and the distal extensor retinaculum were recorded.Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.RESULTS EIP was ulnar to the EDCI in 96.5%of specimens(28/29)at the distal edge of the extensor retinaculum.In the remaining specimen,EIP was volar to EDCI.Tendon circumference at the distal extensor retinaculum averaged(9.3 mm±1.7 mm)for EDCI and 11.1 mm(±2.7 mm)for EIP(P=0.0010).The tendon circumference at the index MCP joint averaged 11.0 mm(±1.7 mm)for EDCI and 10.6 mm(±2.1 mm)for EIP(P=0.33).EIP had a greater circumference in 76%(22/29)of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31%(9/29)of specimens at the MCP joint.CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum,which can be taken into consideration for tendon transfers involving EIP.
