Distal nerve transfer from the median nerve lumbrical fibers to the distal ulnar nerve motor branches in the palm: An anatomical cadaveric study.

BACKGROUND: The aim of the current study is to investigate the first and second lumbrical nerves as potential fibers donors to the deep motor branch of the ulnar nerve to avoid intrinsic atrophy in high ulnar nerve injuries. METHODS: Sixteen fresh frozen cadaveric hands were dissected, the radial lumbrical nerves accessed, and a coaptation, either in reverse end-to-side or in double end-to-side through a bridge nerve graft, was created to the deep motor branch of ulnar nerve. Semithin sections were taken from samples of donor and recipient nerves for qualitative (nerve architecture) and quantitative studies (fiber count and donor/recipient ratio). RESULTS: The first lumbrical showed a robust trunk and a superior axon density (9,126.50 ± 2,923.41 axons/mm2 ) to the ulnar motor branch (7,506.50 ± 1,137.50 axons/mm2 distal to the opponens tunnel and 7,947.75 ± 1,741.24 axons/mm2 before its terminal branching); the ulnar motor branch showed a higher axon number (2,633.51 ± 410.00 distal to the opponens tunnel and 2,345.75 ± 2,101.56 before its terminal branching) than the first lumbrical (1,410.56 ± 823.89); section areas occupied by axons were higher in proximal (0.20 ± 0.16) and distal (0.26 ± 0.20) ulnar samples than the first lumbrical (0.17 ± 0.16). Donor/recipient ratio first lumbrical/deep motor branch of the ulnar nerve were 1:1.86 (distal to the opponens tunnel) and 1:1.67 (at its terminal branching); data about the second lumbrical were ruled out because of bias. CONCLUSIONS: A transfer from the first lumbrical nerve to the deep motor branch of the ulnar nerve in palm is suitable to avoid intrinsic atrophy.

Lipograft in cicatricial ectropion.

AIM: Cicatricial ectropion is secondary to an excessive scar contraction after trauma, burns, skin conditions, scarring skin tumours, medication, allergies, blepharoplasty complications 1,2. The estimates for ectropion incidence following removal of eyelid lesions have been reported as varying from 2.5% to 7% 3. A variety of surgical techniques can be applied to achieve the correct shape and position of lower lid 4-7. Fat grafts in association with other technique are commonly used in orbital reconstruction in a variety of procedures 8 including of the correction of cicatricial ectropion 9,10. MATERIAL OF STUDY: The Authors propose the use of fat graft as only procedure for the correction of cicatricial lower eyelid ectropion. Two male patients with cicatricial ectropion were treated with this technique in two time and followed for 12 months. RESULTS: Lipofilling for cicatricial eyelid ectropion give excellent outcomes, with release of the scar without recurrence, 11. DISCUSSION: Autologous fat grafting has many clinical applications, and its use in Plastic Surgery is increasing: The key point is the presence into fat of Adipose stem cells (ASCs), that have been identified as an ideal source of cells for regenerative medicine, with potential and rapid improvement of healing process and complete recovery of tissue integrity after surgery to confirm the regenerative effect of fat graft. CONCLUSION: Lipografting can be considered a safe and effective alternative procedure 12,13. KEY WORDS: Defect of lower lid, Ectropion, Lipograft.