Nerve transfer (AIN) to deep branch of the ulnar

nerve (UN) cadaveric dissection

First Nerve transfer workshop,KTPH, SingaporePractical - 3

Tophography

Exploration of Deep Motor Branch of the Ulnar Nerve

• Incise just radial to the pisiform• Open Guyon’s canal• Identify deep motor branch of ulnar nerve at level of hook of hamate• Follow nerve proximally for approximately 2 inches from distal wrist

crease to proximal border of pronator quadratus

Identification of the AIN• Retract all flexor tendons radially

• The AIN runs over the interosseous membrane and enters the muscle centrally together with the anterior interosseous artery

• Release the proximal 1/3 of the PQ in the line of the nerve

• The nerve enters the muscle at this point on its dorsal surface

Identification of the AIN

• Distal dissection till muscle branches• A vascular pedicle to FCU crosses the AIN proximal to PQ and must be

released to gain sufficient length for the transfer• Complete the external neurolysis using rubber loop retraction before

dividing

Neurolysis of the motor component from sensory component

• Divide the motor fascicle of the ulnar nerve as proximally as possible

• Coapt with 9’0 sutures

Thank You