Nerve transfers from branches to the flexor carpi radialis and pronator teres to reconstruct the radial nerve.

PURPOSE: To present our method and results for transferring branches of the median nerve for radial nerve palsy or posterior cord lesions. METHODS: We transferred 1 branch to the pronator teres to the branch to the extensor carpi radialis longus muscle and transferred the branch to the flexor carpi radialis to the posterior interosseous nerve. We carried out these transfers in 6 patients with radial nerve palsy or posterior cord lesions. We reviewed functional outcomes, Disabilities of the Arm, Shoulder and Hand scores, and Patient Evaluation Measure scores. RESULTS: After 20 months of follow-up evaluation, all patients had recovered extensor carpi radialis longus activity of M4. Activity of the extensor carpi ulnaris was M3 in 2 patients and M4 in 4 patients. Extensor pollicis longus activity was M4 in all 6 cases. Metacarpophalangeal extension was M4 in 4 cases and M3 in 2 cases. The mean Disabilities of the Arm, Shoulder, and Hand score was 26 (range, 7-43), and the mean Patient Evaluation Measure score was 34 (range, 24-53). CONCLUSIONS: Selective independent synergistic transfer of median nerve fascicles to the radial nerve branches has shown excellent results in the treatment of severe lesions of the radial nerve. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Oblique triangular neurovascular osteocutaneous flap for hook nail deformity correction.

Hook nail deformity results in aesthetic and functional problems after fingertip amputations. Previously described techniques do not correct the osseous defect, which may be the principle cause of the problem. We present a surgical technique based on a compound homodigital advancement flap combining bone of the distal phalanx, finger pulp, and skin. We describe this technique, report a case, and discuss the advantages over former techniques.