FOR THE MEDICAL PRACTITIONER
Plastic Surgery
doi: 10.25005/2074-0581-2024-26-2-488-495
ONE-STAGE CORRECTION OF CHRONIC ULNAR NERVE INJURIES

M.KH. MALIKOV1, M.A. KHASANOV1, N.A. MAKHMADKULOVA2

1Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: : To enhance the outcomes of surgical treatment for chronic ulnar nerve injuries by performing one-stage correction.

Methods: From 2015 to 2023, 11 patients with chronic ulnar neurovascular bundle (NVB) injuries underwent one-stage reconstruction to restore hand function. The operations were performed on 8 men and 3 women aged 16 to 23. The duration of treatment for patients from the time of injury varied from 1.2 years to 5 years

Results: In cases where there was a diastasis between the neural ends of no more than 3 cm in the upper third of the forearm due to nerve damage, restoration of the nerve with epineural suture was performed in 2 patients, while in two other cases with more significant gaps of 3.5 and 5 cm, epineural repair was carried out after anterior transposition of the nerve trunk. In one case of nerve damage in the middle third of the forearm, epineural sutures were applied to a 2.5 cm gap. Among 6 patients with damage to the ulnar NVB in the lower third of the forearm, 4 received epineural restoration of the ulnar nerve, and autologous neuroplasty was performed in gaps exceeding 3 cm in 2 patients. In cases of damage to the ulnar artery, 3 patients received autologous vein grafting, while in 3 other cases, there were no indications for vascular reconstruction. No infectious or inflammatory complications were observed in the immediate postoperative period, and there were no cases of thrombosis of autologous vein grafts of the ulnar artery. After evaluating all patients for 6 months to 2 years, it was found that 9 cases showed favorable and satisfactory long-term functional outcomes, while 2 cases exhibited unsatisfactory results.

Conclusion: Restoring hand function after damage to the ulnar nerve is greatly influenced by the location, extent, and type of the damage, as well as the choice of an appropriate reconstruction method. Breaking the procedure into multiple stages can prolong patient recovery and negatively impact treatment outcomes. Conversely, performing the operation in a single stage within a relatively short timeframe can restore hand function and significantly reduce overall treatment and rehabilitation time

Keywords: Ulnar nerve, neurovascular bundle, injury, tendon-muscular transfer, epineural suture.

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References
  1. Stavrakakis IM, Daskalakis II, Margarakis GE, Christoforakis Z, Katsafarou MS. Ulnar nerve injuries post closed forearm fractures in pediatric population: A review of the literature. Clin Med Insights Pediatr. 2019;13:1179556519841876. https://doi.org/10.1177/1179556519841876
  2. Afina ET, Nadezhdina MV. Sravnitel'naya otsenka vosstanovleniya provodimosti raznykh stvolov (puchkov) plechevogo spleteniya na fone lechebnoy elektroimpul'snoy stimulyatsii pri travmaticheskoy plechevoy pleksopatii [Comparative evaluation of restoration of conductivity of different sources (bunks) of the brachial plexus on the background of therapeutic electric pulse stimulation in traumatic brachial plexopathy]. Vestnik fizioterapii i kurortologii. 2018;24:175-5.
  3. Terzis JK, Barmpitsioti, A. Axillary nerve reconstruction in 176 posttraumatic plexopathy patients. Plast Reconstr Surg. 2010;125:233-47. https://doi. org/10.1097/PRS.0b013e3181c496e4
  4. Zatolokina MA, Mantulina LA, Lipatov VA. K voprosu o mikroskopicheskom stroenii perifericheskikh nervov zadney poverkhnosti plecha v oblasti sredney treti [On the microscopic structure of the peripheral nerves of the posterior surface of the shoulder in the middle third]. Fundamental’nye issledovaniya. 2015;4(1):748-51.
  5. Felippe MM, Telles FL, Soares ACL, Felippe FM. Anastomosis between median nerve and ulnar nerve in the forearm. Journal of Morphological Sciences. 2012;29:23-6.
  6. Ghoraba SM, Mahmoud WH, Elsergany MA, Ayad HM. Ulnar nerve injuries (Sunderland Grade V): A simplified classification system and treatment algorithm. Plast Reconstr Surg Glob Open. 2019;7(11):e2474. https://doi. org/10.1097/GOX.0000000000002474
  7. Khvisyuk NI, Goloborodko SA, Ramaldanov SK. Ul'trasonograficheskoe issledovanie posle peredney podkozhnoy transpozitsii loktevogo nerva [Ultrasound diagnosis after anterior subcutaneous transposition of the ulnar nerve]. Novosti khirurgii. 2016;24(3):265-8.
  8. Coulet B, Boretto JG, Lazerges C, Chammas M. A comparison of intercostal and partial ulnar nerve transfers in restoring elbow flexion following upper brachial plexus injury (C5-C6+/-C7). J Hand Surg Am. 2010;35(8):1297-303. https://doi. org/10.1016/j.jhsa.2010.04.025
  9. Miroshnikova PK, Lyundup AV, Batsalenko NP, Krasheninnikov ME, Zhang Y, Feldman NB, i dr. Perspektivnye nervnye konduity dlya stimulyatsii regeneratsii povrezhdyonnykh perifericheskikh nervov [Perspective nerve conduits for stimulation of regeneration of damaged peripheral nerves]. Vestnik RAMN. 2018;73(6):388-400. https://doi.org/10.15690/vramn1063
  10. Campodonico A, Pangrazi PP, De Francesco F, Riccio M. Reconstruction of a long defect of the median nerve with a free nerve conduit flap. Arch Plast Surg. 2020;47(2):187-93. https://doi.org/10.5999/aps.2019.00654
  11. Poppler LH, Davidge K, Lu JC, Armstrong J, Fox IK, Mackinnon SE. Alternatives to sural nerve grafts in the upper extremity. Hand (NY). 2015;10(1):68-75. https:// doi.org/10.1007/s11552-014-9699-6
  12. Dowdle SB, Chalmers PN. Management of the ulnar nerve in throwing athletes. Curr Rev Musculoskelet Med. 2020;13(4):449-56. https://doi.org/10.1007/ s12178-020-09639-7
  13. Asilova SU, Nurimov GK, Nazarova NZ. Lechenie deformatsiy kisti i pal'tsev pri povrezhdeniyakh luchevogo nerva [Treatment of hand and finger deformities for radial nerve injuries]. Geniy ortopedii. 2009;2:55-7.
  14. Aleksandrov AV, Smirnov AA, Goncharuk PV, Rybchyonok VV, Khagurov RA. Rezul'taty khirurgicheskogo lecheniya travmaticheskikh povrezhdeniy loktevogo, sredinnogo i luchevogo nervov u detey: sistematicheskiy obzor i metaanaliz [Results of surgical treatment of traumatic ulnar, median and radial nerves injuries in children: Systematic review and meta-analysis]. Voprosy rekonstruktivnoy i plasticheskoy khirurgii. 2022;25(4):6-14. https://doi.org/10.52581/1814- 1471/83/01
  15. Baltzer H, Woo A, Oh C, Moran SL. Comparison of ulnar intrinsic function following supercharge end-to-side anterior interosseous-to-ulnar motor nerve transfer: A matched cohort study of proximal ulnar nerve injury patients. Plast Reconstr Surg. 2016;138(6):1264-72. https://doi.org/10.1097/ PRS.0000000000002747
  16. Koriem E, El-Mahy MM, Atiyya AN, Diab RA. Comparison between supercharged ulnar nerve repair by anterior interosseous nerve transfer and isolated ulnar nerve repair in proximal ulnar nerve injuries. J Hand Surg Am. 2020;45(2):104-10. https://doi.org/10.1016/j.jhsa.2019.11.005

Authors' information:

Malikov Mirzobadal Khalifaevich,
Doctor of Medical Sciences, Associate Professor, Head of the Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: ABG-2983-2021
Scopus ID: 21934165100
ORCID ID: 0000-0002-7816-5521
Author ID: 375497
E-mail: mmirzobadal@mail.ru

Khasanov Mukhammadsharif Abdusattorovich,
Postgraduate Student, Department of Surgical Diseases № 2 named after Academician N.U. Usmanov,
Avicenna Tajik State Medical University
ORCID ID: 0000-0002-2840-3472
SPIN: 2109-5394
E-mail: doc3292@mail.ru

Makhmadkulova Nigora Akhtamovna,
Candidate of Medical Sciences, Assistant of the Department of Topographic Anatomy and Operative Surgery, Avicenna Tajik State Medical University
ORCID ID: 0000-0002-4269-6611
E-mail: malikovanigora@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from companies manufacturing medications and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Khasanov Mukhammadsharif Abdusattorovich Postgraduate Student,
Department of Surgical Diseases № 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University

734026, Republic of Tajikistan, Dushanbe, Sino str., 29-31

Tel.: +992 (985) 801738

E-mail: doc3292@mail.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

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