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Anterior interosseous to ulnar nerve transfer with an ultrasound-guided short-incision
Lilly F Stadelmeier1, Julius H A Asschenfeldt1, Laura Hilbig-Vlatten1
1Division of Orthoplastic and Reconstructive Microsurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
Introduction:
The anterior interosseous nerve (AIN) to ulnar nerve transfer is an established procedure for restoring intrinsic hand function in high ulnar nerve injury and severe cubital tunnel syndrome. Conventional techniques require extensive dissection along the distal forearm and across the wrist flexion crease, which may increase wound complications and delay recovery.
Methods:
A modified ultrasound-guided, short-incision technique is described. Preoperative ultrasound is used to localize the AIN and the dorsal sensory branch of the ulnar nerve, enabling a targeted 4-cm incision proximal to the wrist crease. The AIN is mobilized and coapted to the ulnar motor fascicles over an extended contact length, with minimal epineurial fixation and optional biologic wrapping.
Results:
The technique allows targeted exposure of the relevant structures while minimizing soft-tissue dissection and avoiding the wrist flexion crease. The extended coaptation provides an increased contact surface between donor and recipient nerve fibers.
Conclusion:
This ultrasound-guided, short-incision modification represents a reproducible and minimally invasive technical refinement of AIN-to-ulnar nerve transfer. Clinical outcome studies are required to determine its impact on morbidity and recovery.
