What techniques are used in subcutaneous transposition for ulnar neuropathy?

Updated: Jun 08, 2018
  • Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

A commonly used technique involves the creation of a fasciodermal sling. A 1- to 1.5-cm square flap of antebrachial fascia based on the apex of the medial epicondyle is raised and reflected medially. The nerve is transposed anterior to this flap, and the apex is then sutured to the dermal tissue approximately 1 cm anterior to the medial epicondyle.

Another technique is to use a subcutaneous-to-fascial sling. About 2 cm of the subcutaneous fascia of the anterior skin flap is sutured to the flexor-pronator fascia, just anterior to the epicondyle, to keep the nerve in the transposed position.

A third technique is to create a fascial sling by using the medial intermuscular septum. The intermuscular septum is divided 3-4 cm proximal to its insertion on the medial epicondyle, with the distal attachment kept intact. The nerve is transposed. The septum is then used as either a myofascial or a fasciodermal sling to prevent posterior subluxation of the nerve. Care must be taken to prevent kinking of the nerve at the sling. Finally, a simple soft compressive dressing is applied, and early active ROM is instituted.


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