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Surgical Tutorial – Ulnar Index of Median to Ulnar Ring of Ulnar Sensory Nerve Transfer and Prevention of Proximal Neuroma. For distal sensory ulnar nerve injuries in the hand, there is an alternative approach in restoration of critical ulnar nerve sensation. In this case, the patient had a gunshot wound and required amputation of the small finger. As result, the ulnar aspect of the ring finger became the critical target for sensory reinnervation. In addition, soft tissue coverage of the palm was an obstacle for long nerve grafts. Goals were to restore critical sensation and prevent painful neuroma formation. The median nerve branch to the ulnar aspect of the index finger was used as the donor nerve to reinnervate the recipient ulnar nerve branch to the ulnar aspect of the ring finger. A nerve graft was required to bridge the distance and the ulnar sensory fascicle proximal to the injury was harvested as expendable graft material. An acellularized nerve allograft is used to extend the proximal end of the ulnar sensory fascicle for proximal transposition. To preserve rudimentary sensation to the donor nerve, an end-to-side nerve transfer to the lateral aspect of the long finger is completed.