Grome Luke J, Agrawal Nikhil A, Wang Eric, Netscher David T
Division of Plastic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Tex.
Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Tex.
Plast Reconstr Surg Glob Open. 2020 Jul 14;8(7):e2979. doi: 10.1097/GOX.0000000000002979. eCollection 2020 Jul.
Sensory nerve trauma at the level of the wrist can lead to debilitating neuromas. Targeted muscle reinnervation (TMR) is an effective therapy for the treatment of neuromas. Here we propose the use of the terminal anterior interosseous nerve (AIN) as a viable recipient for TMR. All superficial sensory nerves around the wrist, including the dorsal ulnar sensory nerve, the distal lateral antebrachial cutaneous nerve, the distal branches of the superficial branch of the radial nerve, and the palmar cutaneous branch of the median nerve were dissected in 2 cadaver specimens. The AIN branch to pronator quadratus was divided just distal to the final branch of flexor pollicis longus to preserve adequate length for TMR. The sensory nerves at the wrist were fully dissected to identify a viable location for coaptation to the AIN. After the cadaveric concept was demonstrated, the technique was successfully used in a clinical case. In summary, the distal AIN is a versatile recipient for TMR as a treatment of painful sensory neuromas at the level of the wrist, with minimal donor-site morbidity.
腕部水平的感觉神经损伤可导致使人衰弱的神经瘤。靶向肌肉再支配（TMR）是治疗神经瘤的一种有效疗法。在此，我们提议将骨间前神经终末支（AIN）用作TMR的可行受区。在2具尸体标本中解剖了腕部周围的所有浅感觉神经，包括尺背侧感觉神经、前臂外侧皮神经远支、桡神经浅支的远侧分支以及正中神经的掌皮支。至旋前方肌的AIN分支在拇长屈肌最后分支的远侧切断，以保留足够的长度用于TMR。充分解剖腕部的感觉神经，以确定与AIN进行吻合的可行部位。在尸体上验证了该概念后，该技术成功应用于1例临床病例。总之，AIN远侧支是TMR治疗腕部水平疼痛性感觉神经瘤的通用受区，供区并发症极少。
