Article

The paralysis of the deep branch of ulnar nerve has major
consequences on the motricity of the hand that will be felt as more handicapping
by the patient than the sensory deficit. The current treatment of ulnar nerve
lesions is suture or nerve graft in first intention and is essentially palliative
in case of failure. We were interested in the anatomy of the anterior
interosseous nerve and the deep branch of ulnar nerve to know if neurotization
using direct suture of these two branches was possible in every case. METHODS: Our anatomical study was done on 15 upper limbs. We dissected the
branch of the anterior interosseous nerve innervating the pronator quadratus
muscle and performed an intraneural dissection of the deep branch of ulnar nerve.
The distance between these two branches was then measured. RESULTS: The mean
distance separating the deep branch of ulnar nerve and the anterior interosseous
nerve is 2.5mm (-10-10). The direct suture of these two branches is possible in
every case of this study. The macroscopic calibre of both branches is similar.
DISCUSSION: Our study shows that the neurotization of the deep branch of ulnar
nerve with the anterior interosseous nerve is possible in every case using direct
suture, the wrist can be immobilised temporarily in flexion to reduce the
tension. Ustun et al. as well as Wang and Zhu showed that their calibre and the
number of axons is similar. We think that neurotization of the deep branch of
ulnar nerve with the anterior interosseous nerve can be realized in first
intention in case of high lesion of ulnar nerve. There is no major functional
loss due to the paralysis of the pronator quadratus muscle. CONCLUSION:
Neurotization of the deep branch of ulnar nerve with the anterior interosseous
nerve has no major functional loss and gives possible recovery of all the
intrinsic muscles innervated by the deep branch of ulnar nerve. This
neurotisation can be considered as an alternative to the usual techniques of
direct suture or nerve graft, in case of lesion above mid forearm.
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Langue : FRANCAIS