FUNCTIONAL RESULTS OF LOW MEDIAN AND ULNAR NERVE REPAIR WITH INTRANEURAL FASCICULAR DISSECTION AND ELECTRICAL FASCICULAR ORIENTATION

Twenty-eight low median nerve injuries and 23 low ulnar nerve injuries were repaired using intraneural fascicular dissection and electrical fascicular orientation. Eleven freshly lacerated nerves were seen with in 48 hours after injury; 40 nerve lacerations were chronic. Fascicula r orientation between sensory and motor fascicles at the proximal nerv e end could be accurately differentiated in 47 nerves (92%) independen t of whether it was acute or chronic. At the distal nerve end in fresh lacerations, the motor fascicles could be determined conclusively by muscle contraction with sequential electrical stimulation of the fasci cles. In chronic nerve lacerations, the distal fascicles could be esti mated anatomically after internal neurolysis. After fascicular orienta tion, nerves were repaired with end-to-end group fascicular suture or interfascicular sural nerve grafting. Twenty-four nerves repaired with end-to-end suture and 13 nerves repaired with nerve grafting were mon itored more than 25 months. Satisfactory sensory results (i.e., S3+ or S4 functions) were obtained in 29 nerves (78%) and M4 or M5 motor fun ctions were achieved in 29 nerves (78%). There were no patients who ne eded additional tendon transfers to reconstruct thumb opposition or to correct claw finger deformity. These results suggest that low median or ulnar nerve lacerations, whether acute or chronic, partial or compl ete, may be successfully repaired with the aid of electrical fascicula r orientation with or without intraneural fascicular dissection. Copyr ight (C) 1998 by the American Society for Surgery of the Hand.