The feasibility of the lateral antebrachial cutaneous nerve transfer for median sensory restoration: a cadaveric study

Abstract

Purpose: Median nerve injuries can result in substantial functional deficits with both motor and sensory components. Sensory loss results in impaired hand function. The most important areas are the ulnar and radial aspects of the thumb and index finger, respectively. This study aimed to evaluate the feasibility of nerve transfer from the lateral antebrachial cutaneous nerve (LACN) to the median nerve for restoring hand sensation. Methods: This study used 16 cadaveric upper limbs. After dissecting the LACN and its branches, the length and size were recorded. The median nerve was identified via mid-palm and intra-fascicular dissection back from the first common digital nerve (FCDN) to the anterolateral fascicles of the median nerve (ALMN) at the distal forearm level. The simulated nerve transfer was performed. The coaptation site was measured with reference to the radial styloid (RS). Nerve stumps from the coaptation site were histologically examined. Results: Twelve formalin-preserved and four fresh-frozen cadavers were dissected with a mean age of 72.3 ± 20.3 years. Measured from the RS, the mean coaptation site was 5.72 ± 1.75 cm. The mean diameters of the LACN and ALMN were 1733.54 ± 484.44 µm and 1370.38 ± 556.09 µm, respectively. The LACN and ALMN had a mean number of 4 ± 1.8 and 3.4 ± 1.9 fascicles, respectively, with mean fascicular diameters of 406.09 ± 210.47 µm and 634.23 ± 247.74 µm. Conclusions: LACN-to-ALMN transfer is feasible using a tension-free coaptation at around 5 cm from the RS. The LACN and recipient site are histologically compatible in terms of the diameter and number of fascicles. This transfer technique can be used to restore important areas of hand sensation in cases of median nerve injury or neuropathy. Clinical relevance: This study proposes anatomical and histological insights into the nerve transfer for sensory restoration of the median nerve.