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The Interfascicular Nerve-Grafting of the Median and Ulnar Nerves
H. MILLESI; G. MEISSL; A. BERGER
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I. Chirurgische Universitatsklinik, Alserstrasse 4, A 1090, Vienna, Austria
1972 by The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 1972 Jun 01;54(4):727-750
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Abstract

A technique of nerve-grafting based on experimental studies is described. Complete absence of tension at the suture site is regarded as the most important factor for a successful nerve repair. Nerve regeneration after grafting without tension is much better than after direct end-to-end suture under moderate tension even though the regenerating axons must cross two suture lines when grafts are used. The technique involves use of a dissecting microscope to perform an intraneural dissection of both nerve stumps to isolate the major fasciculi individually and the minor ones in groups. The scarred ends of the fasciculi are then resected, the mobilized fasciculi in each nerve stump are matched, and grafts, usually from the sural nerve, are inserted loosely with no tension to bridge the gaps between the matched fasciculi or groups of fasciculi—five or six grafts in the median nerve and usually four in the ulnar nerve. Only one very fine suture is used to fix each end of a graft and the coaption between the ends of the graft and the corresponding fasciculi is carefully adjusted using the dissecting microscope. The results using this technique in thirty-three median and thirty-two ulnar nerve lesions of different types are presented in detail.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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