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

The pedicled ulnar nerve transfer (St. Clair Strange procedure) preserves the intrinsic blood supply to the transferred nerve and allows bridging of large defects in avascular, scarred wounds. We report our indications for this operation, describe the two operative stages, and report the results in seven patients. After operation progressive median nerve axonal growth in a proximal direction up the ulnar nerve was shown by a median nerve Tinel's sign. Five patients followed for a mean of 10 years achieved protective sensibility in the median nerve distribution. In two of the three patients in whom distal nerve repair was done to the median and ulnar nerve, protective sensibility also returned to the ulnar digits. Localization, stereognoses, and vibratory response was achieved in the majority of digits. All patients had active use of the hand, but none had meaningful two-point discrimination. No changes were found after a superficial radial nerve block excluded any radial nerve contribution. No intrinsic motor functional return was noted. Two patients are currently being followed.