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Outcomes of Secondary Reconstruction of Ulnar Nerve Lesions: Our Experience

Terzis, Julia K. M.D., Ph.D.; Kokkalis, Zinon T. M.D.

Plastic & Reconstructive Surgery: October 2008 - Volume 122 - Issue 4 - pp 1100-1110
doi: 10.1097/PRS.0b013e3181858f67
Hand/Peripheral Nerve: Original Articles

Background: The authors' experience in the management of late ulnar nerve injuries is presented.

Methods: A retrospective study of 44 patients with severe ulnar nerve injuries was conducted and the outcomes were analyzed in relation to various factors, such as age at injury, denervation time, level of injury, length of nerve graft, and type of reconstruction (e.g., neurolysis, secondary end-to-end repair, or nerve grafting). Most patients were late cases who were referred to the authors' center for treatment. The mean time between injury and surgery was 14.6 months (range, 2 to 64 months). The mean follow-up period was 2.6 years.

Results: Overall, good and excellent motor results (≥M3+) were seen in 31 of 44 cases (70 percent) and good and excellent sensory results were seen in 28 of 44 cases (64 percent). The age of the patient, level of injury, denervation time, length of nerve graft, and type of surgical reconstruction significantly influenced the functional outcome.

Conclusions: Functional results were significantly better if surgery was performed within 5 months, the length of the graft was 5 cm or less, and the patient was younger than 25 years. Advanced microsurgical techniques, such as interfascicular neurolysis and the use of vascularized nerve grafts or vascularized fascia, should be kept in mind in complex and/or previously failed cases.

Norfolk, Va.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School.

Received for publication September 17, 2007; accepted March 17, 2008.

Presented at the Fourth Congress of the World Society for Reconstructive Microsurgery, in Athens, Greece, June 24 through 26, 2007.

Disclosure: No declared financial interests for either author in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Julia K. Terzis, M.D., Ph.D.; Department of Surgery; Division of Plastic and Reconstructive Surgery; Eastern Virginia Medical School; 700 Olney Road, LH 2055; Norfolk, Va. 23501; jktmd1@aol.com

©2008American Society of Plastic Surgeons