Considering these findings, that the median and ulnar nerves are
completely destroyed at the distal segments, they were cut were
acceptable fibers were noted.
The MCN was exposed and studied. It
was weakly transmitting stimulation to the long head of the biceps
muscle, for what it was left in place intact.
The deltoid muscle was acceptable during direct stimulation of
the muscle. Considering that, the radial nerve was preoperatively
functioning, no attempt was made to explore the radial and axillary
The skin incision was extended inferiorly in the chest area to
expose the intercostal nerves: Th2, 3, 4 and 5. Considering the low
level of injury of both median and ulnar nerves, it was needed to
harvest both sural nerves 35 cm length both. The were divided in 2
parts to have four bridges.
Cross anastamosis was performed between Th2 and 3 to the median
nerve and Th4 and 5 to the ulnar nerve. The suturing was performed
under microscopic facility.
Routine closure of the wounds. Ready-vac drain left in the chest
wound for 24 hours.