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Title: Failed Endoscopic Carpal Tunnel Release and Stem Cell Injection Nerve Reconstruction.
PNS ID: 110307-1, Published: 3/7/2011, Updated: 3/7/2011.

Author(s): Andrew Yee BS, Susan E. Mackinnon MD.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.

Abstract: The following case describes a median nerve injury following an endoscopic carpal tunnel release. The median nerve injury was noted at the time of the surgery and the incision was opened and an attempt was made to repair the median nerve. Unfortunately, the primary reconstruction was not successful and the patient failed medical management, which included a high dose of anti-neuropathic pain medications to relieve her pain. On clinical examination at our institution, she had thenar motor function and normal sensation in her thumb, but otherwise disabling pain and no sensation in the index, long, and radial side of the ring finger. At surgery, the uninjured portion of the median nerve (thenar motor function and sensation to the thumb) was protected. The remainder of the median nerve, which was injured, was managed with nerve grafts. In order to avoid sural nerve graft harvest from her lower extremity, the medial antebrachial cutaneous nerve and the third webspace component of the median nerve proximal to the zone of injury were used for cable grafting. The distal end of the medial antebrachial cutaneous nerve was end-to-side transferred to the sensory component of the median nerve (superior or lateral aspect) in order to recovery rudimentary sensation for donor deficit. Similarly, the distal end of the third webspace was end-to-side transferred to the sensory component of the ulnar nerve to also recovery rudimentary sensation to the non-critical third webspace component of the median nerve. Utilizing a medial antebrachial cutaneous nerve graft and a third webspace nerve graft allowed to keep all donor graft deficits to the same upper extremity.

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