Title: Medial Antebrachial Cutaneous Nerve Graft Harvest.
Published: 4/22/2011, Updated: 4/26/2011.
Author(s): Susan E. Mackinnon MD, Andrew Yee BS.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
The medial antebrachial cutaneous (MABC) nerve is an available donor for nerve grafts and our institution’s preferred donor nerve graft for upper extremity nerve reconstructions. The MABC nerve is harvested from the medial aspect of the arm. Due to this location, only one extremity is required to be prepped for surgery as the MABC nerve can be harvested from the same arm as the nerve reconstruction. The MABC nerve originates from the medial cord, courses distal, and branches into an anterior and posterior branch. The anterior and/or posterior branch can be harvested depending on the length and diameter required for nerve reconstruction. An anatomical landmark used to easily identify the MABC nerve and its branches is the basilic vein, where the anterior branch is found anterior and the posterior branch is found posterior to this vein within the middle arm. Harvesting the MABC nerve will result in a sensory deficient in medial aspect of the forearm. To restore rudimentary sensation to the MABC nerve territory, the MABC nerve is end-to-side transferred to an adjacent functional sensory nerve. That is, the distal end of the transected donor sensory nerve is coaptated to the side of a sensory nerve through an epineurial window. The distal end of the donor MABC nerve can be end-to-side transferred to the sensory component of the median or ulnar nerve. If only the anterior branch is harvested, the distal end can be end-to-side transferred to the remaining posterior branch of the MABC nerve. In select cases, patients have reported full recovery of sensation with no sensory deficit in the MABC nerve territory following the end-to-side nerve transfer. The combination effects of the end-to-side nerve transfer and the spontaneous collateral sprouting from adjacent sensory territories could describe these outcomes.