title: Alternatives to sural nerve grafts in the upper extremity.
abstract: BACKGROUND
  The sural nerve is the most common nerve graft donor despite requiring a second operative limb and causing numbness of the lateral foot. The purposes of this study were to review our experience using nerve autografts in upper extremity nerve reconstruction and develop recommendations for donor selection.
  
  
  METHODS
  A retrospective case series study was performed of all consecutive patients undergoing nerve grafting procedures for upper extremity nerve injuries over an 11-year period (2001-2012).
  
  
  RESULTS
  Eighty-six patients received 109 nerve grafts over the study period. Mean patient age was 42.9 ± 18.3 years; 57 % were male. There were 51 median (59 %), 26 ulnar (30 %), 14 digital (13 %), 13 radial (16 %), and 3 musculocutaneous (4 %) nerve injuries repaired with 99 nerve autografts (71 from upper extremity, 28 from lower extremity). Multiple upper extremity nerve autograft donors were utilized, including the medial antebrachial cutaneous nerve (MABC), third webspace branch of median, lateral antebrachial cutaneous nerve (LABC), palmar cutaneous, and dorsal cutaneous branch of ulnar nerve. By using an upper-extremity donor, a second operative limb was avoided in 58 patients (67 %), and a second incision was avoided in 26 patients (30 %). The frequency of sural graft use declined from 40 % (n = 17/43) to 11 % (n = 7/64).
  
  
  CONCLUSIONS
  Our algorithm for selecting nerve graft material has evolved with our growing understanding of nerve internal topography and the drive to minimize additional incisions, maximize ease of harvest, and limit donor morbidity. This has led us away from using the sural nerve when possible and allowed us to avoid a second operative limb in two thirds of the cases.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8238, St. Louis, MO 63110 USA.
authors.forename: Louis H
authors.initials: LH
authors.lastname: Poppler
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8238, St. Louis, MO 63110 USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Davidge
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8238, St. Louis, MO 63110 USA.
authors.forename: Johnny C Y
authors.initials: JC
authors.lastname: Lu
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8238, St. Louis, MO 63110 USA.
authors.forename: Jim
authors.initials: J
authors.lastname: Armstrong
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8238, St. Louis, MO 63110 USA.
authors.forename: Ida K
authors.initials: IK
authors.lastname: Fox
authors.affiliation: Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8238, St. Louis, MO 63110 USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Mackinnon
keywords: Autograft; Donor; Nerve graft; Nerve transfer; Sural nerve