Autogenous nerve pedicle graft in the forearm.

We report our experience during a 15-year period with three patients who had severe segmental loss of more than 10 cm of both the median and ulnar nerves in the arm and forearm. The procedure was described by St. Clair Strange and by Silverstone in 1947. A modification of the procedure was used in our three patients. In two patients, the proximal stumps of the median and ulnar nerves were sutured together in the proximal forearm. The ulnar nerve was transected high in the axilla, leaving its blood supply intact. Several months later the ulnar nerve was transposed distally, and a juncture with the distal median nerve was created. The third patient had a significant segmental loss in the arm of both the median and ulnar nerves. The distal stumps of the median and ulnar nerves were sutured together, and at a later stage the ulnar nerve was transposed proximally and sutured to the median nerve in the axilla. In all three patients, an advancing Tinel sign was observed. Subjectively, all three patients believed there was a definite improvement in sensibility. Objective testing was, however, less convincing. This operation has limited applicability but definitely has a place in situations where direct sutures or nerve grafting are impossible.