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Topic: Peripheral Nerve Repair and Regeneration

“Babysitting” procedures in proximal nerve

trunk injuries: two case reports and a

review

Michele R. Colonna , Antonio Russo , Mariarosaria Galeano , Gabriele Delia ,
3
1
1
2
Giorgio E. Pajardi , Francesco Stagno d’Alcontres 1
4
1 Department of Experimental Specialistic Medical and Surgical Sciences and Odontostomatology, University of Messina, 98121 Messina, Italy.
2 Department Hand Surgery, Multimedica Hospital, 20122 Milan, Italy.
3 Department of Surgical Specialties, University Hospital of Messina, 98125 Messina, Italy.
4 Department of Clinical and Community Sciences, University of Milan, 20122 Milan, Italy.
Address for correspondence: Prof. Michele R. Colonna, Department of Experimental Specialistic Medical and Surgical Sciences and
Odontostomatology, University of Messina, 98121 Messina, Italy. E-mail: mrcolonna1@gmail.com

ABSTRACT
One of the most important goals in treating proximal nerve injuries is to maintain the function of distal
effectors during axonal regeneration. “Babysitting”, that is, connecting the injured nerve to a healthy
trunk provides a bypass for distal neural regeneration or reactivation. It avoids degeneration of sensory
and motor terminations, with minimal donor nerve damage. We present a technique where a nerve
graft is used between ulnar and median nerve through two end-to-side sutures in the distal third of
the forearm, in two different cases of proximal ulnar nerve injury. Both patients were young manual
workers, the former suffered a total nerve disruption proximal to the elbow following a car accident
and the latter suffered a perineurial scar from a high voltage injury at the proximal third of the forearm.
The proximal injury was grafted with a sural nerve in the former and treated by neurolysis in the latter.
Results were graded by the Highet-Zachary scale for both sensory and motor recovery. The outcomes
of our series were compared to six other case reports in the literature (including median nerves) treated
with this technique. Both clinical and experimental data show that babysitting effectively protects
distal effectors.
Key words:
Denervation, end-to-side neural repair, Martin Gruber anastomosis, nerve graft, sensory recovery

INTRODUCTION employed to bring new axons into distal effectors in
[3]
case of proximal nerve trunk injury to avoid distal effector
Proximal nerve injuries are well‑known to produce degeneration. End‑to‑side nerve repair is a microsurgical
atrophy of the distal effectors. This is evident in injuries technique in which nerve fibers are transferred from
of major nerve trunks in the upper limb. The ulnar nerve an intact donor nerve to a denervated recipient nerve
has shown to have the lowest regenerative rate. [1,2] Distal directly or through a bridge graft. [4‑7] Although the value of
neurotization through end‑to‑side coaptation has been end‑to‑side coaptation is debated in the literature, good
functional results can be achieved when this technique is
applied with special care to the donor nerve. [6]
Access this article online
[5]
Quick Response Code: The “babysitter” procedure combines cross‑facial nerve
Website: grafting with the segmental transfer of the hypoglossal
www.parjournal.net
nerve to the affected facial nerve. This technique has
shown satisfactory to excellent results. In long‑lasting
DOI: paralysis, nonetheless, the babysitter procedure may
10.4103/2347-9264.160888 need to be combined with muscle(s) flap(s) for enhanced
outcomes. [5,8]

208 Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015