الفهرس 
Surgical anatomy of nerves and tendons in distal (below the musculotendinous junction) Forearm.Only 14 pages are availabe for public view
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Abstract
Background: Combined median-ulnar nerve injury at the level of distal forearm
(below the musculotendinous junction) causes a detrimental effect on hand functions, which have a great impact on patients’ hands as well as a financial burden.
Many previous authors advocated early or immediate tendon transfer in solitary
median or ulnar nerve injuries.
Methods: This study included 20 patients with combined distal ulnar-median nerve
injury, who were divided into 2 groups. group I (control) included 10 patients who
underwent primary (group fascicular) repair of both nerves only. group II (study)
included 10 patients underwent primary (group fascicular) repair with immediate
tendon transfer simultaneously: opponenplasty using extensor indicies and adductoplasty extensor carpi radialis brevis with appropriate splinting, postoperative rehabilitation, and biofeedback facilities.
Results: Twenty patients (age: 18–38 years) were affected. The response of median
and ulnar nerves showed invariable results in both groups, whilst the hand grip,
hand pinch, and opposition showed marked improvements in group II. Moreover,
inter-phalangeal and metacarpophalangeal joints of thumb showed no deformities
in group II in comparison with high level of deformities in group I, owing to early
regain of thumb movements.
Conclusions: Immediate (during neurorrhaphy) tendon transfer may offer additional merits over nerve repair only for distal combined ulnar and median injury,
as it offers scarless field, no adhesion, and no joint edema, leading to very early
return to normal hand functions with a consequent decrease of thumb deformities, better hand grip, and key pinch. (Plast Reconstr Surg Glob Open 2021;9:e3597;
doi: 10.1097/GOX.0000000000003597; Published online 27 May 2021.