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Related Experiment Videos

St. Clair Strange procedure: indications, technique, and long-term evaluation.

B M Greenberg1, C L Cuadros, M Panda

  • 1Department of Physical Therapy, Massachusetts General Hospital/Harvard Medical School, Boston 02114.

The Journal of Hand Surgery
|November 1, 1988
PubMed
Summary

The pedicled ulnar nerve transfer (St. Clair Strange procedure) restores protective sensation in the hand after nerve injury. This surgical technique bridges large defects, enabling sensory recovery in most patients after a decade of follow-up.

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Area of Science:

  • Neurosurgery
  • Hand Surgery
  • Peripheral Nerve Repair

Background:

  • The pedicled ulnar nerve transfer (St. Clair Strange procedure) is a surgical technique designed to address large nerve defects, particularly in challenging avascular and scarred wound environments.
  • This procedure aims to preserve the intrinsic blood supply of the transferred nerve, enhancing its viability and potential for regeneration.

Observation:

  • The study details the indications, operative stages, and outcomes of the St. Clair Strange procedure in seven patients.
  • Postoperative assessment included electrodiagnostic studies, such as Tinel's sign, to evaluate axonal growth and sensory recovery.

Findings:

  • Five out of seven patients achieved protective sensibility in the median nerve distribution after a mean follow-up of 10 years.
  • In cases with distal nerve repair to both median and ulnar nerves, protective sensibility extended to the ulnar digits.

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  • While localization, stereognosis, and vibratory response improved in most digits, meaningful two-point discrimination was not achieved in any patient. No intrinsic motor function returned.

    • Implications:

    • The pedicled ulnar nerve transfer is a viable option for restoring protective sensation in hands with significant nerve defects, offering a solution for complex wound scenarios.
    • The procedure demonstrates potential for long-term sensory recovery, although motor function and fine tactile discrimination remain significant challenges.
    • Further research may explore modifications or adjuncts to improve motor recovery and two-point discrimination following this nerve transfer technique.