ONE-STAGE CORRECTION OF CHRONIC ULNAR NERVE INJURIES

Abstract

Objective: : To enhance the outcomes of surgical treatment for chronic ulnar nerve injuries by performing one-stage correction. Methods: From 2015 to 2023, 11 patients with chronic ulnar neurovascular bundle (NVB) injuries underwent one-stage reconstruction to restore hand function. The operations were performed on 8 men and 3 women aged 16 to 23. The duration of treatment for patients from the time of injury varied from 1.2 years to 5 years Results: In cases where there was a diastasis between the neural ends of no more than 3 cm in the upper third of the forearm due to nerve damage, restoration of the nerve with epineural suture was performed in 2 patients, while in two other cases with more significant gaps of 3.5 and 5 cm, epineural repair was carried out after anterior transposition of the nerve trunk. In one case of nerve damage in the middle third of the forearm, epineural sutures were applied to a 2.5 cm gap. Among 6 patients with damage to the ulnar NVB in the lower third of the forearm, 4 received epineural restoration of the ulnar nerve, and autologous neuroplasty was performed in gaps exceeding 3 cm in 2 patients. In cases of damage to the ulnar artery, 3 patients received autologous vein grafting, while in 3 other cases, there were no indications for vascular reconstruction. No infectious or inflammatory complications were observed in the immediate postoperative period, and there were no cases of thrombosis of autologous vein grafts of the ulnar artery. After evaluating all patients for 6 months to 2 years, it was found that 9 cases showed favorable and satisfactory long-term functional outcomes, while 2 cases exhibited unsatisfactory results. Conclusion: Restoring hand function after damage to the ulnar nerve is greatly influenced by the location, extent, and type of the damage, as well as the choice of an appropriate reconstruction method. Breaking the procedure into multiple stages can prolong patient recovery and negatively impact treatment outcomes. Conversely, performing the operation in a single stage within a relatively short timeframe can restore hand function and significantly reduce overall treatment and rehabilitation time

Keywords

• ulnar nerve
• neurovascular bundle
• injury
• tendon-muscular transfer
• epineural suture