Ulnar nerve injury at distal forearm - split sural nerve graft

40 yr old with defence wound to ulnar aspect of distal forearm when assaulted with a knife 3 months back. 0/5 power of ulnar innervated muscles (some atrophy +) . Absent CMAPs and SNAPs.



anesthesia - supraclavicular block and epidural anesthesia for graft harvesting.
Surgery: Split sural nerve graft after neurolysis. Some fascicles were intact in the deeper aspect of the nerve.
Surgeons - I and hari.

Problems: Intraop NAP recordings could not be done as the equipment is currently unavailable. transcluscent 80 ethilon suture is much harder to use compared to silk. Dont underestimate the value of icecream sticks and shaving blades when it come to trimming nerve ends. Cling drapes are good.