title: Very distal sensory nerve transfers in high median nerve lesions.
abstract: OBJECTIVE
  We report on the results of reconstruction of fingertip sensation by very distal nerve transfer in 8 patients with high median nerve lesions.
  
  
  METHODS
  Before surgery, patients underwent sensory testing of the hand using Semmes-Weinstein monofilaments. All patients had surgery within 1 year of trauma. For sensory reconstruction, branches of the radial nerve on the proximal phalanx of the index and thumb were sutured to the ulnar proper digital nerve of the thumb and radial proper digital nerve of the index finger. Patients were followed up for 12 months.
  
  
  RESULTS
  After median nerve lesions, zones of lost protective sensation were confined to the middle and index finger and the thumb. Sensation on the palm of the hand and proximal phalanx was preserved. Radial nerve transfer to palmar nerves restored protective or better sensation to the fingertips in all patients. Better results were observed for the thumb. Locognosia was acquired in all thumbs, and in 4 of 8 index fingers. Good results were detected even in patients who had undergone surgery later than 6 months after injury.
  
  
  CONCLUSIONS
  Fingertip sensation can be restored by very distal nerve transfer of radial nerve branches to palmar nerves at the level of the proximal phalanx. This method of reconstruction appears useful in high median nerve lesions. In chronic lesions of the median nerve at the wrist and lesions in older patients, very distal nerve transfers might be adjunct to nerve grafting.
authors.affiliation: Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil. bertelli@matrix.com.br
authors.forename: Jayme Augusto
authors.initials: JA
authors.lastname: Bertelli
authors.forename: Marcos Flávio
authors.initials: MF
authors.lastname: Ghizoni
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005385:Fingers / Q000294:innervation*; D006801:Humans; D008297:Male; D020423:Median Neuropathy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016067:Nerve Transfer; D011826:Radial Nerve / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D020886:Somatosensory Disorders / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014110:Touch / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult