Schenck Thilo L, Lin Shenyu, Stewart Jessica K, Koban Konstantin C, Aichler Michaela, Rezaeian Farid, Giunta Riccardo E
Hand Surgery, Plastic Surgery and Aesthetic Surgery Ludwig-Maximilians-University Munich Munich Germany.
Department of Obstetrics and Gynecology University Hospital rechts der Isar Technical University Munich Munich Germany.
Brain Behav. 2016 Oct 9;6(12):e00578. doi: 10.1002/brb3.578. eCollection 2016 Dec.
It remains a surgical challenge to treat high-grade nerve injuries of the upper extremity. Extra-anatomic reconstructions through the transfer of peripheral nerves have gained clinical importance over the past decades. This contribution outlines the anatomic and histomorphometric basis for the transfer of the superficial branch of the radial nerve (SBRN) to the median nerve (MN) and the superficial branch of the ulnar nerve (SBUN).
The SBRN, MN, and SBUN were identified in 15 specimens and the nerve transfer performed. A favorable site for coaptation was chosen and its location described using relevant anatomical landmarks. Histomorphometric characteristics of donor and target were compared to evaluate the chances of a clinical success.
A suitable location for dissecting the SBRN was identified prior to its first bifurcation. Coaptations were possible near the pronator quadratus muscle, approximately 22 cm distal to the lateral epicondyle of the humerus. The MN and SBUN had to be dissected interfasciculary over 82 ± 5.7 mm and 49 ± 5.5 mm, respectively. Histomorphometric analysis revealed sufficient donor-to-recipient axon ratios for both transfers and identified the SBRN as a suitable donor with high axon density.
Our anatomic and histomorphometric results indicate that the SBRN is a suitable donor for the MN and SBUN at wrist level. The measurements show feasibility of this procedure and shall help in planning this sensory nerve transfer. High axon density in the SBRN identifies it or its branches an ideal candidate for sensory reanimation of fingers and thumbs.
治疗上肢高级别神经损伤仍然是一项外科挑战。在过去几十年中，通过周围神经移位进行的非解剖学重建已在临床上变得重要。本文概述了将桡神经浅支（SBRN）移位至正中神经（MN）和尺神经浅支（SBUN）的解剖学和组织形态计量学基础。
在15个标本中识别出SBRN、MN和SBUN，并进行神经移位。选择了一个有利于端端吻合的部位，并使用相关解剖标志描述其位置。比较供体和受体的组织形态计量学特征，以评估临床成功的可能性。
在SBRN首次分叉之前确定了一个合适的解剖位置。在旋前方肌附近可以进行端端吻合，该位置在肱骨外侧髁远端约22厘米处。MN和SBUN分别需要在束间解剖82±5.7毫米和49±5.5毫米。组织形态计量学分析显示，两种移位的供体与受体轴突比率均足够，并确定SBRN是具有高轴突密度的合适供体。
我们的解剖学和组织形态计量学结果表明，SBRN是腕部水平MN和SBUN的合适供体。测量结果显示了该手术的可行性，并将有助于规划这种感觉神经移位。SBRN中的高轴突密度使其或其分支成为手指和拇指感觉恢复的理想候选者。
