Sural nerve autografts for high radial nerve injury with nine centimeter or greater defects.

PURPOSE: The purpose of this study is to present the outcome of sural nerve grafting that focuses on motor fascicles in 6 patients with high radial nerve injuries with defects of more than 9 cm.

METHODS

Six patients with a high radial nerve complete injury were treated with a sural nerve autograft during a 6-year interval from June 1994 to June 2000. The gap of the radial nerve, which was measured in the surgical field, was 9 cm in 1 patient, 10 cm in 4 patients, and 11 cm in 1 patient. There were 4 men and 2 women with an average age of 32 years (range, 14-49 years). The causes of the injuries were a fracture of the humerus in 4 patients and surgery-related complications in 2 patients. Two or 3 multiple interfascicular nerve autografts of the sural nerve were sutured to the areas that have motor fascicles dominantly. The average delay from the injury to surgery was 6 months (range, 0.5-12 months), and the average duration of the follow-up after surgery was 48 months.

RESULTS

The overall motor recovery was M5 in 2 patients, M4 in 3 patients, and M2 in 1 patient. The overall sensory recovery was S3+ in 2 patients, S3 in 3 patients, and S1 in 1 patient.

CONCLUSIONS

In summary, good to excellent motor recovery can be expected in 83% of patients who have a large gap of the radial nerve when sural nerve autografts are sutured to the areas that have motor fascicles dominantly. Even for large gaps, within 8 months, an attempt at nerve reconstruction before proceeding to tendon transfers appears to be indicated.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.