Posterior Interosseous Nerve Graft: Utilizing External Landmarks and Anthropometric Ratios to Predict Available Length for Digital Nerve Reconstruction in a Cadaveric Study

Overview

Journal Plast Surg (Oakv)

Specialty General Surgery

Date 2022 May 16

PMID 35572081

Authors

Bradley J Vivace

Swapnil D Kachare

Luke T Meredith

Milind D Kachare

Christina N Kapsalis

Claude Muresan

Joshua H Choo

Morton L Kasdan

Bradon J Wilhelmi

Affiliations

Soon will be listed here.

Abstract

Objective: In digital nerve defects that require grafting, autografts remain the efficacious option. The sensory posterior interosseous nerve (PIN) is an ideal choice as it is of similar caliber to digital nerves and leaves no donor morbidity upon resection. However, a finite length of harvestable PIN exists, and considerable variations of this length have been reported in the literature. There exists no predictive model to estimate this length. We sought to determine a method to accurately predict the available length of PIN based on individual patient anthropometry.

Methods: A cadaveric dissection study was performed in a fresh tissue laboratory. The length of the sensory branch of the PIN and various anthropometric measurements were made in respect to surface anatomy of the ulna to develop a predictable ratio for available PIN donor graft.

Results: A total of 16 specimens were obtained. On average the length of the PIN was 5.7 cm (range: 3.3-9. cm) and the length of the ulna was 25.7 cm (range: 23.5-30.6 cm). The ratio of PIN to ulnar length was 0.222 ( = 0.4651). Using one-fifth the length of the ulna, the mean predicted length of the PIN was 5.14 cm (range: 4.7-6.1 cm). On univariate analysis, there was no significant difference between the measured and predicted PIN length ( = .249).

Conclusion: An anthropometric ratio predicated on reproducible surface anatomy of the ulna is a useful tool in predicting the sensory PIN length. Such a prediction may be a useful in guiding patient discussions concerning surgical options for digital nerve reconstruction.

References

Hinds R, Gottschalk M, Capo J . The Pronator Quadratus and Distal Anterior Interosseous Nerve: A Cadaveric Study. J Wrist Surg. 2015; 4(3):183-7. PMC: 4530181. DOI: 10.1055/s-0035-1556858. View

Chan Y . Biostatistics 104: correlational analysis. Singapore Med J. 2004; 44(12):614-9. View

Mahakkanukrauh P, Chomsung R . Anatomical variations of the sural nerve. Clin Anat. 2002; 15(4):263-6. DOI: 10.1002/ca.10016. View

Grutter P, DeSilva G, Meehan R, DeSilva S . The accuracy of distal posterior interosseous and anterior interosseous nerve injection. J Hand Surg Am. 2004; 29(5):865-70. DOI: 10.1016/j.jhsa.2004.05.012. View

Nunley J, Ugino M, Goldner R, Regan N, Urbaniak J . Use of the anterior branch of the medial antebrachial cutaneous nerve as a graft for the repair of defects of the digital nerve. J Bone Joint Surg Am. 1989; 71(4):563-7. View

Elgafy H, Ebraheim N, Yeasting R . The anatomy of the posterior interosseous nerve as a graft. J Hand Surg Am. 2000; 25(5):930-5. DOI: 10.1053/jhsu.2000.16359. View

Ray W, Mackinnon S . Management of nerve gaps: autografts, allografts, nerve transfers, and end-to-side neurorrhaphy. Exp Neurol. 2009; 223(1):77-85. PMC: 2849924. DOI: 10.1016/j.expneurol.2009.03.031. View

Patterson R, Van Niel M, Shimko P, Pace C, Seitz Jr W . Proprioception of the wrist following posterior interosseous sensory neurectomy. J Hand Surg Am. 2010; 35(1):52-6. DOI: 10.1016/j.jhsa.2009.10.014. View

Wallace W, Coupland R . Variations in the nerves of the thumb and index finger. J Bone Joint Surg Br. 1975; 57(4):491-4. View

10.

Pilanci O, Ozel A, Basaran K, Celikdelen A, Berkoz O, Akoz Saydam F . Is there a profit to use the lateral antebrachial cutaneous nerve as a graft source in digital nerve reconstruction?. Microsurgery. 2014; 34(5):367-71. DOI: 10.1002/micr.22220. View

11.

Jariwala A, Krishnan B, Soames R, Wigderowitz C . Important anatomical relationships of the posterior interosseous nerve in the distal forearm for surgical planning: a cadaveric study. J Wrist Surg. 2014; 3(1):60-3. PMC: 3922858. DOI: 10.1055/s-0034-1365828. View

12.

Abrams R, Ziets R, Lieber R, Botte M . Anatomy of the radial nerve motor branches in the forearm. J Hand Surg Am. 1997; 22(2):232-7. DOI: 10.1016/S0363-5023(97)80157-8. View

13.

Ortiz R, Westenberg R, Langhammer C, Knaus W, Chen N, Eberlin K . Nerve Diameter in the Hand: A Cadaveric Study. Plast Reconstr Surg Glob Open. 2019; 7(3):e2155. PMC: 6467622. DOI: 10.1097/GOX.0000000000002155. View

14.

Tubbs R, Salter E, Wellons 3rd J, Blount J, Oakes W . Superficial surgical landmarks for identifying the posterior interosseous nerve. J Neurosurg. 2006; 104(5):796-9. DOI: 10.3171/jns.2006.104.5.796. View

15.

Reissis N, Stirrat A, Manek S, Dunkerton M . The terminal branch of posterior interosseous nerve: a useful donor for digital nerve grafting. J Hand Surg Br. 1992; 17(6):638-40. DOI: 10.1016/0266-7681(92)90190-d. View

16.

Gay A, Harbst K, Hansen D, Laskowski E, Berger R, Kaufman K . Effect of partial wrist denervation on wrist kinesthesia: wrist denervation does not impair proprioception. J Hand Surg Am. 2011; 36(11):1774-9. DOI: 10.1016/j.jhsa.2011.07.027. View

17.

Ehretsman R, Novak C, Mackinnon S . Subjective recovery of nerve graft donor site. Ann Plast Surg. 1999; 43(6):606-12. DOI: 10.1097/00000637-199912000-00005. View

18.

Mermans J, Franssen B, Serroyen J, van der Hulst R . Digital nerve injuries: a review of predictors of sensory recovery after microsurgical digital nerve repair. Hand (N Y). 2012; 7(3):233-41. PMC: 3418375. DOI: 10.1007/s11552-012-9433-1. View

19.

Chiavaras M, Jacobson J, Billone L, Lawton J, Lawton J . Sonography of the lateral antebrachial cutaneous nerve with magnetic resonance imaging and anatomic correlation. J Ultrasound Med. 2014; 33(8):1475-83. DOI: 10.7863/ultra.33.8.1475. View

20.

Kim Y, Ha D, Lee S . Ultrasonographic findings of posterior interosseous nerve syndrome. Ultrasonography. 2017; 36(4):363-369. PMC: 5621806. DOI: 10.14366/usg.17007. View