Intraoperative iatrogenic nerve injuries occur despite vigilance in the operating room. Most of these injuries occur as a result of patient positioning, traction or pressure injury, hematoma, or technical error. The median nerve is especially susceptible to injury during carpal tunnel release. A rare but devastating injury of the median nerve is complete transection. The number of devastating injuries is not well known, as few of the injuries are documented or publicized. We report a case where the median nerve was harvested instead of the palmaris longus tendon. We present a review of the literature and suggest an alternative treatment to median nerve grafting using sensory nerve transfers in the hand.
BrunelliGA. Sensory nerves transfers. J Hand Surg [Br]2004;29 (6):557–62.
2.
ChapmanCBRisticSRosenwasserMRComplete median nerve transection as a complication of carpal tunnel release with a carpal tunnel tome. Am J Orthop2001;30(8):652–3.
3.
ChassardMPhamEComtetJJ. Two-point discrimination tests versus functional sensory recovery in both median and ulnar nerve complete transections. J Hand Surg [Br]1993;18(6):790–6.
4.
DoiKKuwataNKawakamiFTamaruKKawaiS. The free vascularized sural nerve graft. Microsurgery1984;5(4): 175–84.
5.
EderG. Endoscopic carpal tunnel release without iatrogenic complication—a report about 1000 procedures. Handchir Mikrochir Plast Chir2003;35(1):57–62.
6.
FremlingMAMackinnonSE. Injection injury to the median nerve. Ann Plast Surg1996;37(5):561–7.
7.
GeldmacherJ. Median nerve as free tendon graft. Hand1972;4 (1):56.
8.
HaapaniemiTBerggrenMAdolfssonL. Complete transection of the median and radial nerves during arthroscopic release of posttraumatic elbow contracture. Arthroscopy1999;15(7):784–7.
9.
HaaseJBjerrePSimesenK. Median and ulnar nerve transections treated with microsurgical interfascicular cable grafting with autogenous sural nerve. J Neurosurg1980;53(1):73–84.
KhanRBirchR. Iatropathic injuries of peripheral nerves. J Bone Jt Surg Br2001;83(8):1145–8.
12.
KovacsyA. Removal of the median nerve instead of the palmaris longus tendon. Magy Traumatol Orthop Helyreall Seb1980;23 (2): 156–8.
13.
KretschmerTAntoniadisGBraunVRathSARichterHPEvaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma. J Neurosurg2001;94(6):905–12.
14.
MurphyRXJrJenningsJFWukichDK. Major neurovascular complications of endoscopic carpal tunnel release. J Hand Surg [Am]1994;19(1):114–8.
15.
PalmerAKToivonenDA. Complications of endoscopic and open carpal tunnel release. J Hand Surg [Am]1999;24(3):561–5.
16.
SinghRMechelseKHopWCBraakmanR. Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique. Surg Neurol1992;37(6):425–31.
17.
StrauchBLangAFerderMKeyes-FordMFreemanKNewsteinD. The ten test. Plast Reconstr Surg1997;99(4):1074–8.
18.
ThompsonNWMockfordBJCranGW. Absence of the palmaris longus muscle: a population study. Ulster Med J2001;70(1):22–4.
19.
TrohaFBaibakGJKelleherJC. Frequency of the palmaris longus tendon in North American Caucasians. Ann Plast Surg1990;25(6):477–8.
20.
VastamakiM. Median nerve as free tendon graft. J Hand Surg [Br]1987;12(2):187–8.
21.
WatsonME. Median nerve damage from brachial artery puncture: a case report. Respir Care1995;40(11):1141–3.
22.
WeberRVMackinnonSE. Nerve transfers in the upper extremity. J Am Soc Surg Hand2004;4(3):200–13.
