The median and ulnar nerves can also be used as donors for sensory transfers. For critical median nerve sensation, the dorsal cutaneous branch or noncritical branches of the ulnar nerve or median nerve can be used at the level of the hand or distal forearm. In the palm, the ulnar nerve branch to the fourth web space can be transferred directly end-to-end to the median branch to the first web space. To restore protective sensation to the noncritical donor territories such as the third or fourth web space, Dr. Barbour frequently performs an end-to-sidecoaptation of the distal stump of the donor nerve branch back to a nearby functioning branch of the median or ulnar nerve.
The third web space branch of the median nerve can also be used to restore more critical ulnar border digit sensation in a high ulnar nerve injury or upper brachial plexus palsy.This transfer can also be performed in the palm or as a sensory fascicular transfer in the distal forearm. In the forearm, the internal topography of both the median and ulnar nerves is predictable. The motor and sensory components of both nerves are identified and separated. Especially the median fascicle to the third web space can be readily neurolysed for more than half the length of the forearm proximal to the wrist.
Dr. Barbour transfers digital nerve branches in the palm when using the fourth web space branch of the ulnar nerve as the donor. The technique of fascicular transfer at the distal forearm is preferred when the median nerve is the donor to restore ulnar nerve sensation using the whole sensory component as the recipient. For incomplete median nerve lesions or upper brachial plexus injury (C5 to C6), the sensory fascicle to the third web space can be transferred to the first web space for critical thumb and index finger sensation.
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