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organs (both motor and sensory). [1,2] Nerve babysitting [3‑5] using epineurial windows bridged with autologous vein as
provides distal effector organs (muscle, skin) reinnervation shown in a previous study. [15]
through end‑to‑side and side‑to‑side neurotization coming Six cases have been published in the literature. First,
from healthy donor nerves when a proximal nerve Kayikcioglu et al. reported 2 cases of neural graft
[9]
trunk repair has been done. The rationale of using this bridging the median and ulnar nerve (creating a Martin
technique are: (a) distal sensory corpuscles (Pacinian and Gruber connection distal to the injury) just proximal to
Meissner) as well as motor plates undergo atrophy after the wrist in a case of a median nerve cut at the elbow and
denervation; (b) creating a connection distal to the injury, of ulnar injury 5 cm proximal to the medial epicondyle.
[1]
in a safe territory with the least damage to the donor They reported poor motor sand sensate results. Afterward
nerve is a desirable goal when repairing a proximal nerve Magdi Sherif and Amr reported 4 patients with ulnar
[10]
injury. [3‑5,8] However, experimental studies reported that or median nerve proximal lesions, which were treated
mixing sensory and motor axons allows gain of sensation with a modified Kayikcioglu’s technique for comparison
but fails in motor reinnervation. Moreover, Wallerian of main features of injuries and repair [Table 1]. In this
[11]
degeneration with time produces a poorer turnover and paper, we report our experience with the application of
attraction of Schwann cells as well as a lower production a modified Kayikcioglu’s technique to 2 patients. To date,
of specific neurite growth factors; [12‑14] and (c) both clinical a total of 8 proximal nerve injuries have been treated by
and experimental evidences have showed that donor this method (includes two cases from this report): 5 ulnar
axons can be induced into a recipient trunk through an and 3 median nerves.
opening of the epiperineurial connective tissue, [3,6] and
the capability of axonal attraction through a nerve graft Magdi Sherif and Amr reported their best results in
[10]
used as a bridge through two different nerve trunks has median nerve effector protection; dealing with ulnar
also been demonstrated. This could also be achieved nerve, they report a good result in a proximal (arm)
[4]
Table 1: Comparing main features of nerve injuries in the published series
Study Patient Gender/ Nerve Level of Trauma Repair and Protection Follow-up Outcome
number age injury time from (months) M and S
(years) trauma
Kayikcioglu 1 Male/35 Median Mid left arm Window pane Sural graft 6 cm Cross nerve graft 18 S and M
et al. [9] laceration two cables; above the wrist; poor
during 16 months after donor of axons:
a seizure ulnar
2 Male/58 Ulnar Mid right Aggression Direct Cross nerve graft 21 S and M
arm immediate above the wrist poor
exploration and (four cables from
repair sural); donor of
axons: median
Magdi Sherif 1 Male/34 Median Left forearm Tangential Sural graft four Cross nerve graft 12 Complete
and Amr [10] elbow trauma cables; third in palm between S and M
disruption intervention motor branches recovery
after trauma (one cable); donor
of axons: ulnar
2 Male/23 Ulnar Mid left Broken glass Sural graft Cross nerve graft 9 M3 S3
forearm three cables; 6 above the wrist
months after (one cable); donor
of axons: median
3 Female/49 Ulnar Medial Broken glass No mention Cross nerve graft 9 M4; no
aspect arm (direct?); above the wrist mention of S
2 months after (one cable); donor
of axons: median
4 Female/8 Median Left cubital Broken glass Direct; Cross nerve graft 4 M3; no
fossa immediate above the wrist mention of S
exploration and (one cable); donor
repair of axons: ulnar
Colonna et al. 1 Male/26 Ulnar Left lower Tangential Sural graft Cross nerve graft 18 M and S
(in this series) third arm trauma nerve six cables; above the wrist poor
disruption 1-month after (one cable from
trauma medial cutaneous
antebrachii); donor
of axons: median
2 Male/47 Ulnar Left middle High-voltage Neurolysis; Cross nerve graft 18 Complete
forearm injury 3 months after above the wrist recovery
(one cable from
cutaneous medialis
antebrachii); donor
of axons: median
M: Motor, S: Sensate
210 Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015