a distal nerve transfer of the anterior interosseous nerve (AIN) to the deep motor branch of the ulnar nerve

1. Nerve transfer (AIN) to deep
branch of the ulnar nerve (UN)
cadaveric dissection
First Nerve transfer workshop,
KTPH, Singapore
Practical - 3

4. Tophography

5. Exploration of Deep Motor Branch of the
Ulnar Nerve
• Incise just radial to the pisiform
• Open Guyon’s canal
• Identify deep motor branch of ulnar nerve at level of hook of hamate
• Follow nerve proximally for approximately 2 inches from distal wrist
crease to proximal border of pronator quadratus

11. Identification of the AIN
• Retract all flexor tendons radially
• The AIN runs over the interosseous membrane and enters the muscle
centrally together with the anterior interosseous artery
• Release the proximal 1/3 of the PQ in the line of the nerve
• The nerve enters the muscle at this point on its dorsal surface

20. Identification of the AIN
• Distal dissection till muscle branches
• A vascular pedicle to FCU crosses the AIN proximal to PQ and must be
released to gain sufficient length for the transfer
• Complete the external neurolysis using rubber loop retraction before
dividing

25. Neurolysis of the motor component from
sensory component

29. • Divide the motor fascicle of the ulnar nerve as proximally as possible
• Coapt with 9’0 sutures

30. Thank You