The feasibility of the lateral antebrachial cutaneous nerve transfer for median sensory restoration: A cadaveric study

The feasibility of the lateral antebrachial cutaneous nerve transfer for median sensory restoration: A cadaveric study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The feasibility of the lateral antebrachial cutaneous nerve transfer for median sensory restoration: A cadaveric study Thepparat Kanchanathepsak, Chanakarn Rojpitipongsakorn, Jariya Waisayarat, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7646302/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Dec, 2025 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 7 You are reading this latest preprint version Abstract Purpose: Median nerve injuries can result in substantial functional deficits with both motor and sensory components. Sensory loss results in impaired hand function. The most important areas are the ulnar and radial aspects of the thumb and index finger, respectively. This study aimed to evaluate the feasibility of nerve transfer from the lateral antebrachial cutaneous nerve (LACN) to the median nerve for restoring hand sensation. Methods: This study used 16 cadaveric upper limbs. After dissecting the LACN and its branches, the length and size were recorded. The median nerve was identified via mid-palm and intra-fascicular dissection back from the first common digital nerve (FCDN) to the anterolateral fascicles of the median nerve (ALMN) at the distal forearm level. The simulated nerve transfer was performed. The coaptation site was measured with reference to the radial styloid (RS). Nerve stumps from the coaptation site were histologically examined. Results: Twelve formalin-preserved and four fresh-frozen cadavers were dissected with a mean age of 72.3 ± 20.3 years. Measured from the RS, the mean coaptation site was 5.72 ± 1.75 cm. The mean diameters of the LACN and ALMN were 1733.54 ± 484.44 µm and 1370.38 ± 556.09 µm, respectively. The LACN and ALMN had a mean number of 4 ± 1.8 and 3.4 ± 1.9 fascicles, respectively, with mean fascicular diameters of 406.09 ± 210.47 µm and 634.23 ± 247.74 µm. Conclusions: LACN-to-ALMN transfer is feasible using a tension-free coaptation at around 5 cm from the RS. The LACN and recipient site are histologically compatible in terms of the diameter and number of fascicles. This transfer technique can be used to restore important areas of hand sensation in cases of median nerve injury or neuropathy. Clinical relevance: This study proposes anatomical and histological insights into the nerve transfer for sensory restoration of the median nerve Lateral antebrachial cutaneous nerve Median sensory restoration Nerve transfer Sensory restoration Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Median nerve injury or neuropathy can result in substantial disability caused by motor and sensory deficits of the hand. 1 While there are many procedures for restoring motor function (e.g., tendon transfer or motor nerve transfer), sensory loss is often overlooked, even if it can also impair hand function and quality of life. 2 Sensory function is important in activities of daily living, serving as a prerequisite for good motor function. It is crucial for the fine motor movements, such as pinching, which is used in grasping and object manipulation. 3 – 6 Many studies have focused on restoring median nerve sensation, particularly in the ulnar side of the thumb and radial side of the index finger, to improve pinching. However, their results remain debatable, and no standard methods despite investigating multiple donors, such as the superficial radial nerve (SRN), 3rd or 4th common digital nerve, and dorsal cutaneous branch of the ulnar nerve. 2 , 3 , 5 , 7 – 10 Nevertheless, protective sensation can still be restored with nerve transfers, specifically those of the distal nerve, compared to proximal transfer. 7 , 10 The lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve, which runs along the radial aspect of the forearm. Since the volar branch of the LACN has an anatomical landmark close to the median nerve, this makes nerve transfer feasible. The recipient of the transfer would be the digital nerve of the thumb and index finger, which is a branch of the first common digital nerve (FCDN) of the median nerve. A previous study of the topography of the median nerve revealed that the anterolateral fascicle of the median nerve (ALMN) at the wrist level of the distal forearm reliably ran along the FCDN, which supplies the ulnar side of the thumb and radial side of the index finger. 11 , 12 This study aimed to evaluate the feasibility of LACN-to-ALMN nerve transfer to restore sensory deficits of the thumb and index finger, particularly in cases of proximal-level median nerve injury without any nerve recovery after nerve repair or nerve graft, or for chronic median neuropathy at any level without sensory recovery after nerve decompression. Methods After approval from the Institutional Review Board, the cadaveric study was conducted from December 2021 to February 2022. This study included 16 cadaveric upper limbs (eight from each side) from 12 formalin-preserved cadavers and four fresh frozen cadavers aged 18–80 years old. The cadaveric specimens were thawed at room temperature on the day of dissection. Cadavers with a history of upper limb trauma/surgery, underlying peripheral neuritis, or anatomical distortion were excluded. The total forearm length was measured from the cubital crease to the radial styloid. Dissection was performed under 2.5X loupe magnification. A volar longitudinal incision was created just radial to the flexor carpi radialis (FCR) tendon, then the LACN was identified and dissected in the subcutaneous layer (Fig. 1 ). The number of LACN branches at the distal forearm level was measured and recorded. After extending the distal incision to the mid-palm level, the FCDN was identified in the first webspace between the thumb and index finger (Fig. 2 ). Internal neurolysis and fascicular dissection of the FCDN was performed; it was traced back to confirm that the fascicle to the ulnar side of the thumb and the radial side of the index finger was located at the anterolateral side of the median nerve at the distal forearm (Figs. 3.1 and 3.2). The only one terminal branch of the LACN was transected at an appropriate level for the intended size while ensuring tension-free transfer to the ALMN, passing under the FCR tendon. Afterward, a nerve coaptation was created through an end-to-end fashion using Nylon 9 − 0 (Fig. 4 ). The distance from the radial styloid to the coaptation site was measured via vernier calipers by two examiners and recorded. Descriptive statistics are reported as the mean ± standard deviation. Histological study Tissue samples from the LACN terminal branch and ALMN were collected from the coaptation site. The samples were fixed in formalin and then embedded in paraffin. The nerves were prepared into cross-sections, then stained using hematoxylin and eosin (Fig. 5 ). The nerve cross-sectional diameter, number of fascicles, and diameter of the fascicles were measured and recorded. Descriptive statistics are reported as the mean ± standard deviation. Results This study included 16 cadaveric upper limbs (12 formalin-preserved and four fresh-frozen) from four males and four females with a mean age of 72.3 ± 20.3 years old. The mean forearm length, measured from the cubital crease to the radial styloid process, was 23.6 ± 1.2 cm. The anatomical study revealed that the LACN had an average of 2.6 ± 0.9 branches, with its terminal branch found at the distal forearm level. Dissection of the median nerve revealed that the fascicles to the ulnar side of the thumb and radial side of the index finger, as well as the FCDN, were located on the anterolateral side of the median nerve at the distal forearm level. The LACN could be successfully transferred to the ALMN using a tension-free coaptation at 5.72 ± 1.75 cm from the radial styloid process. The nerve coaptation site was near the location of the palmar cutaneous nerve branching from the median nerve. There were landmarks for dissecting the ALMN at this location and at the coaptation site as well. Based on the histological study, the LACN and ALMN had mean nerve diameters of 1733.54 ± 484.44 µm and 1370.38 ± 556.09 µm, respectively. The mean number of fascicles was 4 ± 1.8 and 3.4 ± 1.9, with mean diameters of 406.09 ± 210.47 µm and 634.23 ± 247.74 µm, respectively. Discussion Restoring sensory function in the hand is a prerequisite for restoring motor and active hand function, and thus, distal sensory nerve transfer complements motor reconstruction. 3 , 5 , 13 Significant disability can arise from a lack of sensation in important areas of the hand, such as the radial border of the index finger and the ulnar border of the thumb (supplied by the median nerve) or the ulnar border of the small finger (supplied by the ulnar nerve). 3 In cases of median nerve injury, sensory loss is predominantly seen in the fingertips rather than the palm, and reinnervation via grafting was ineffective in a previous report. 7 However, many nerve transfer procedures can restore sensory function in the hand. Ozkan et al. 3 used digital nerves from the middle, ring, or little finger, as well as the SRN, as donors for restoring sensation in the median nerve, specifically in the radial border of the index finger and ulnar border of the thumb. Their method was reliable, with improved hand function after the procedure, although the outcomes were dependent on timing, age, and patient education. Meanwhile, Brunelli used the SRN, the fourth common digital nerve, and the dorsal branch of the ulnar nerve as donors to the radial digital nerve of the index finger and ulnar digital nerve of the thumb, yielding satisfactory outcomes and restoration of protective pain sensation. 5 Nerve transfer for restoration of the median nerve sensation has previously been performed in patients with complete brachial plexus injury as well. The intercostal or intercostobrachial nerves have been used as donors to the lateral or medial cord in order to restore median nerve sensation. The studies of Ihara and Foroni resulted in favorable outcomes with good sensory intensity, whereas the study of Hattori resulted in limited hand sensibility but was nevertheless useful for activities of daily living. 14 – 16 The uncertain outcome caused by the nerve transfer, which does not directly coaptation to the median nerve and also involves proximal transfer, provided a poorer outcome than the distal transfer based on the principle of nerve regeneration. 5 The LACN is a pure sensory nerve that travels along the radial border of the forearm; its proximity to the median nerve makes it a suitable donor for median sensory restoration. The LACN is an expandable donor that is close to the recipient site, enabling direct coaptation to the sensory fascicle without tension or the need for an interposition nerve graft. In a previous study, LACN transfer was used to restore ulnar nerve sensation in adults with C8–T1 brachial plexus injury and children with brachial plexus birth palsy, resulting in good protective sensation. 17–19 In the present study, the LACN served as the donor nerve to the ALMN, which provides the fascicle to the FCDN that provides sensation to the ulnar side of the thumb and radial side of the index finger. As confirmed by our dissection, the FCDN is reliably located on the anterolateral portion of the median nerve at the distal forearm level. Likewise, a previous study on the topography of the median nerve revealed that the sensory fascicle innervating the ulnar side of the thumb and radial side of the index finger is always found on the lateral side of the median nerve. 11 , 20 We demonstrated that the terminal branch of the LACN could be transferred to the median nerve using a tension-free coaptation at about 5 cm proximal to the radial styloid process. The similarities of the LACN and ALMN in terms of diameter and number of fascicles make them compatible. Based on the principles of nerve regeneration, nerve coaptation should be done as distally as possible with the shortest distance to facilitate nerve growth, and thus, we used the LACN at the distal forearm level. 5 No articles have reported complications of neuropathic pain or complaints of donor site morbidity after using LACN as a donor nerve. 3 , 7 , 10 , 17 Moreover, there is less sensory deficit seen at the donor site, which can be attributed to the superimposed innervation between the palmar cutaneous branch of the median nerve and LACN, as well as the interconnection and overlap between the LACN and SRN. 8 , 21 This procedure has valuable clinical applications. Based on the anatomical study, this technique can be performed only at the distal forearm level. Thus, the natural cleavage plane and visual neurolysis could be leveraged for a faster surgical approach. 13 Even though the nerve coaptation was performed by the unilateral side of each index finger and thumb, the one-sided nerve repair of the palmar digital nerve ensures sensory recovery of the entire pulp. 7 End-to-side coaptation of sensory nerve transfer is feasible in this technique. Similarly, Brown et al. demonstrated end-to-side reinnervation of the dorsal ulnar cutaneous nerve, which gradually improved sensory recovery. 13 The limitations of this study include a small sample size, and a large number of cadavers would be required to demonstrate the precise outcome, and some variation in the anatomy. The histological study of the axon count was not performed due to limitations of our equipment; however, the number of fascicles and size were matched between the two nerves. Furthermore, the study reported only the anatomical feasibility of the sensory nerve transfer; however, the clinical studies will be conducted in the future. Conclusion LACN-to-ALMN transfer is a feasible procedure for sensory restoration, done using a tension-free coaptation at an average of 5 cm proximal to the radial styloid process. Additionally, the LACN and recipient site are also histologically compatible in terms of the diameter and number of fascicles. This technique is considered a treatment option for sensory restoration in patients with median nerve injury or neuropathy. Declarations Ethics approval and consent to participate This study was approved by the ethics committees of the Faculty of Medicine Ramathibodi Hospital, Mahidol University (MURA2021/717). We confirm that all methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable Availability of data and materials Not applicable Competing interests I declare that the authors have no competing interests Funding This research received funding from the Faculty of Medicine Ramathibodi Hospital, Mahidol University Authors' contributions T.K. contributed to the conception, design of the work, investigation, and wrote the main manuscript. C.R. collected the data, investigation, analysis, interpretation, and wrote the manuscript. J.W. analysis and interpretation. I.W., T.T., and P.T. reviewed and revised the manuscript. Acknowledgements Not applicable References Franco MJ, Nguyen DC, Phillips BZ, Mackinnon SE. Intraneural Median Nerve Anatomy and Implications for Treating Mixed Median Nerve Injury in the Hand. Hand (N Y) . 2016 Dec;11(4):416-420. Schenck TL, Lin S, Stewart JK, et al. Sensory reanimation of the hand by transfer of the superficial branch of the radial nerve to the median and ulnar nerve. Brain Behav . 2016;6(12):e00578. Ozkan T, Ozer K, Gulgonen A. Restoration of sensibility in irreparable ulnar and median nerve lesions with use of sensory nerve transfer: Long-term follow-up of 20 cases. J Hand Surg . 2001;26A:44-51. Monzée J, Lamarre Y, Smith AM. The Effects of Digital Anesthesia on Force Control Using a Precision Grip. J Neurophysiol . 2003 Feb;89(2):672-83. Brunelli GA. Sensory nerves transfers. J Hand Surg Br . 2004 Dec;29(6):557-62. Dun S, Kaufmann RA, Li ZM. Lower median nerve block impairs precision grip. J Electromyogr Kinesiol . 2007 Jun;17(3):348-54. Bertelli JA, Ghizoni MF. Very distal sensory nerve transfers in high median nerve lesions. J Hand Surg Am . 2011 Mar;36(3):387-93. Bertelli JA. Distal sensory nerve transfer in lower-type injuries of the brachial plexus. J Hand Surg Am . 2012 Jun;37(6):1194-9. Moore AM, Franco M, Tung TH. Motor and Sensory Nerve Transfers in the Forearm and Hand. Plast Reconstr Surg . 2014 Oct;134(4):721-730. Duraku LS, Hundepool CA, Moore AM, et al. Sensory nerve transfers in the upper limb after peripheral nerve injury: a scoping review. J Hand Surg Eur . 2024;49(8):946-955. Planitzer U, Steinke H, Meixensberger J, Bechmann I, Hammer N, Winkler D. Median nerve fascicular anatomy as a basis for distal neural prostheses. Ann Anat . 2014;196:144-149. Soubeyrand M, Melhem R, Protais M, Artuso M, Creze M. Anatomy of the median nerve and its clinical applications. Hand Surg Rehabil . 2020 Feb;39(1):2-18. Brown JM, Yee A, Mackinnon SE. Distal median to ulnar nerve transfer to restore ulnar motor and sensory function within the hand: technical nuances. Neurosurgery . 2009;65(5):966-77. Ihara K, Doi K, Sakai K, Kuwata N, Kawai S. Restoration of sensibility in the hand after complete brachial plexus injury. J Hand Surg Am . 1996 May;21(3):381-6. Foroni L, Siqueira MG, Martins RS, Heise CO, Neto HS, Imamura AY. Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor. Arq Neuropsiquiatr . 2017 Nov;75(11):796-800. Hattori Y, Doi K, Sakamoto S, Yukata K. Sensory Recovery of the Hand with Intercostal Nerve Transfer following Complete Avulsion of the Brachial Plexus. Plast Reconstr Surg . 2009 Jan;123(1):276-283. Oberlin C, Teboul F, Severin S, Beaulieu JY. Transfer of the lateral cutaneous nerve of the forearm to the dorsal branch of the ulnar nerve, for providing sensation on the ulnar aspect of the hand. Plast Reconstr Surg . 2003 Oct;112(5):1498-50. Ruchelsman DE, Price AE, Valencia H, Ramos LE, Grossman John AI. Sensory restoration by lateral antebrachial cutaneous to ulnar nerve transfer in children with global brachial plexus injuries. Hand (N Y) . 2010 Dec;5(4):370-3. Pauchot J, Assouline U, Valmary-Degano S, Constantinou B, Obert L, Lepage D. Transfer of the lateral antebrachial cutaneous nerve to the dorsal branch of the ulnar nerve without nerve graft in case of lower brachial plexus injuries: Anatomical and feasibility study. Hand Surg Rehabil . 2017 Sep;36(4):296-300. Paulin E, Bowen EC, Dogar S, et al. A comprehensive review of topography and axon counts in upper-extremity peripheral nerves: A guide for neurotization. J Hand Surg GO . 2024;6(2024):784-795. Kanchanathepsak T, Rojpitipongsakorn C, Tawonsawatruk T, Suppaphol S, Watcharananan I, Tuntiyatorn P. The Lateral Antebrachial Neurocutaneous Flap: A Cadaveric Study and Clinical Applications. J Reconstr Microsurg . 2020 Sep;36(7):541-548. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 28 Dec, 2025 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Accepted 26 Nov, 2025 Reviews received at journal 13 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers invited by journal 12 Oct, 2025 Editor assigned by journal 12 Oct, 2025 Submission checks completed at journal 07 Oct, 2025 First submitted to journal 06 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7646302","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":525151946,"identity":"86e9dee1-0830-4b5a-9ca3-3119c6fea6fb","order_by":0,"name":"Thepparat 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08:55:03","extension":"jpg","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":281561,"visible":true,"origin":"","legend":"","description":"","filename":"Fig5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/d7a721558492ea1ae1caea9a.jpg"},{"id":93023795,"identity":"756364ac-ab65-400b-bc96-de1a0d700f88","added_by":"auto","created_at":"2025-10-08 09:11:04","extension":"png","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":127773,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig1.png","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/caa06f5f111f5194fb309194.png"},{"id":93023794,"identity":"0aa098cb-233e-47fb-b4b4-7c36f4939174","added_by":"auto","created_at":"2025-10-08 09:11:04","extension":"png","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":285000,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig2.png","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/e2f6ddad1cdb881edd64205e.png"},{"id":93022422,"identity":"cb50e486-3cd6-45b5-9d05-e3495ae28927","added_by":"auto","created_at":"2025-10-08 09:03:04","extension":"png","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":322859,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig3.1.png","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/98eb9e9c9c16f59ced6aeef4.png"},{"id":93021924,"identity":"5984e37d-0c6b-4c64-9c6b-c093fe627dcc","added_by":"auto","created_at":"2025-10-08 08:55:04","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":506509,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig3.2.png","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/c14614aed4b9134759a16363.png"},{"id":93021929,"identity":"63fe1e38-05d9-4647-bc09-45ea58c7e30b","added_by":"auto","created_at":"2025-10-08 08:55:04","extension":"png","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":276128,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig4.png","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/e8a5312c6a982c6818d3b63b.png"},{"id":93021926,"identity":"665f06ef-ed95-494f-876b-67f769b23b12","added_by":"auto","created_at":"2025-10-08 08:55:04","extension":"png","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":254971,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig5.png","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/e687e4c9253663cbdecabced.png"},{"id":93021931,"identity":"1aa0cb87-30b3-464d-b133-45adab0b32be","added_by":"auto","created_at":"2025-10-08 08:55:04","extension":"xml","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":58588,"visible":true,"origin":"","legend":"","description":"","filename":"2a9a9c693f6149f0bb82b2ba0f64b66a1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/d2a196e1514821da58130f6f.xml"},{"id":93021934,"identity":"639b68ca-4c14-41b6-9a31-b23fd1610876","added_by":"auto","created_at":"2025-10-08 08:55:04","extension":"html","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67795,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/e211b8bbda0daefe7a38c07e.html"},{"id":93021907,"identity":"d46250d7-aca3-4420-bd2a-dda1ada562b8","added_by":"auto","created_at":"2025-10-08 08:55:03","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":139650,"visible":true,"origin":"","legend":"\u003cp\u003eThe lateral antebrachial cutaneous nerve (LACN) and its branches were dissected at the volar-radial side of the left distal forearm.\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/055558d5a8c3d4c162d3e130.jpg"},{"id":93021914,"identity":"278c90d4-932a-4f71-9c1e-49e596127455","added_by":"auto","created_at":"2025-10-08 08:55:03","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":306527,"visible":true,"origin":"","legend":"\u003cp\u003eDemonstrates the first common digital nerve (*) at the first web space area of the right hand, which branches off to the ulnar digital nerve of the thumb and the radial digital nerve of the index finger. **, recurrent motor branch of the median nerve.\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/f4afaef0fd7590891f3124d8.jpg"},{"id":93021911,"identity":"faf0e6ac-e6fe-41b9-a347-0b1f44cd0922","added_by":"auto","created_at":"2025-10-08 08:55:03","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":352746,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3.1\u003c/strong\u003e Dissection of the right distal forearm shows a closed relationship between LACN and the median nerve; the FCR was retracted ulnarly.\u003c/p\u003e","description":"","filename":"Fig3.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/0049a8f40939fc13bd8bfa0c.jpg"},{"id":93024774,"identity":"e34cd90f-fff3-4733-9c53-adc26201e73d","added_by":"auto","created_at":"2025-10-08 09:19:03","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":534489,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3.2\u003c/strong\u003e Dissected at the distal forearm level, FCDN was traced back to the anterolateral fascicle of the median nerve (ALMN, **) near the palmar cutaneous branch of the median nerve (***) branch off, and the FCR was retracted radially; LACN (*).\u003c/p\u003e","description":"","filename":"Fig3.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/67aa3f74815af6aeba8ef147.jpg"},{"id":93021913,"identity":"67992e2b-7b2a-4964-8883-b9e3b749616c","added_by":"auto","created_at":"2025-10-08 08:55:03","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":313114,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 4\u003c/strong\u003e Demonstrated tension-free end-to-end coaptation of LACN and ALMN on left distal forearm; dorsal branch of LACN (*); distal stump of LACN (**); FCR, flexor carpi radialis.\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/e7a45c776ca7236d35f72c64.jpg"},{"id":93021919,"identity":"277b4553-3db7-44fd-b0b0-701a8b55f390","added_by":"auto","created_at":"2025-10-08 08:55:03","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":281561,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 5\u003c/strong\u003e. A cross-section with hematoxylin and eosin stain at the coaptation site of LACN (left) and median nerve (right) shows the number and size of fascicles.\u003c/p\u003e","description":"","filename":"Fig5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/8b4768836b018c6c75f95c33.jpg"},{"id":99172505,"identity":"1fdfe6f9-dd27-468e-be00-ef1b3e8bdb84","added_by":"auto","created_at":"2025-12-29 16:10:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2410445,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7646302/v1/ac6be1cf-87f5-4984-bb2b-26c637140604.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The feasibility of the lateral antebrachial cutaneous nerve transfer for median sensory restoration: A cadaveric study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMedian nerve injury or neuropathy can result in substantial disability caused by motor and sensory deficits of the hand.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e While there are many procedures for restoring motor function (e.g., tendon transfer or motor nerve transfer), sensory loss is often overlooked, even if it can also impair hand function and quality of life.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Sensory function is important in activities of daily living, serving as a prerequisite for good motor function. It is crucial for the fine motor movements, such as pinching, which is used in grasping and object manipulation.\u003csup\u003e\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eMany studies have focused on restoring median nerve sensation, particularly in the ulnar side of the thumb and radial side of the index finger, to improve pinching. However, their results remain debatable, and no standard methods despite investigating multiple donors, such as the superficial radial nerve (SRN), 3rd or 4th common digital nerve, and dorsal cutaneous branch of the ulnar nerve.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Nevertheless, protective sensation can still be restored with nerve transfers, specifically those of the distal nerve, compared to proximal transfer.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve, which runs along the radial aspect of the forearm. Since the volar branch of the LACN has an anatomical landmark close to the median nerve, this makes nerve transfer feasible. The recipient of the transfer would be the digital nerve of the thumb and index finger, which is a branch of the first common digital nerve (FCDN) of the median nerve.\u003c/p\u003e\u003cp\u003eA previous study of the topography of the median nerve revealed that the anterolateral fascicle of the median nerve (ALMN) at the wrist level of the distal forearm reliably ran along the FCDN, which supplies the ulnar side of the thumb and radial side of the index finger.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate the feasibility of LACN-to-ALMN nerve transfer to restore sensory deficits of the thumb and index finger, particularly in cases of proximal-level median nerve injury without any nerve recovery after nerve repair or nerve graft, or for chronic median neuropathy at any level without sensory recovery after nerve decompression.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAfter approval from the Institutional Review Board, the cadaveric study was conducted from December 2021 to February 2022. This study included 16 cadaveric upper limbs (eight from each side) from 12 formalin-preserved cadavers and four fresh frozen cadavers aged 18\u0026ndash;80 years old. The cadaveric specimens were thawed at room temperature on the day of dissection. Cadavers with a history of upper limb trauma/surgery, underlying peripheral neuritis, or anatomical distortion were excluded. The total forearm length was measured from the cubital crease to the radial styloid.\u003c/p\u003e\u003cp\u003eDissection was performed under 2.5X loupe magnification. A volar longitudinal incision was created just radial to the flexor carpi radialis (FCR) tendon, then the LACN was identified and dissected in the subcutaneous layer (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The number of LACN branches at the distal forearm level was measured and recorded. After extending the distal incision to the mid-palm level, the FCDN was identified in the first webspace between the thumb and index finger (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Internal neurolysis and fascicular dissection of the FCDN was performed; it was traced back to confirm that the fascicle to the ulnar side of the thumb and the radial side of the index finger was located at the anterolateral side of the median nerve at the distal forearm (Figs.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3.1\u003c/span\u003e and 3.2). The only one terminal branch of the LACN was transected at an appropriate level for the intended size while ensuring tension-free transfer to the ALMN, passing under the FCR tendon. Afterward, a nerve coaptation was created through an end-to-end fashion using Nylon 9\u0026thinsp;\u0026minus;\u0026thinsp;0 (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The distance from the radial styloid to the coaptation site was measured via vernier calipers by two examiners and recorded. Descriptive statistics are reported as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eHistological study\u003c/h2\u003e\u003cp\u003eTissue samples from the LACN terminal branch and ALMN were collected from the coaptation site. The samples were fixed in formalin and then embedded in paraffin. The nerves were prepared into cross-sections, then stained using hematoxylin and eosin (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The nerve cross-sectional diameter, number of fascicles, and diameter of the fascicles were measured and recorded. Descriptive statistics are reported as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study included 16 cadaveric upper limbs (12 formalin-preserved and four fresh-frozen) from four males and four females with a mean age of 72.3\u0026thinsp;\u0026plusmn;\u0026thinsp;20.3 years old. The mean forearm length, measured from the cubital crease to the radial styloid process, was 23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 cm. The anatomical study revealed that the LACN had an average of 2.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 branches, with its terminal branch found at the distal forearm level.\u003c/p\u003e\u003cp\u003eDissection of the median nerve revealed that the fascicles to the ulnar side of the thumb and radial side of the index finger, as well as the FCDN, were located on the anterolateral side of the median nerve at the distal forearm level. The LACN could be successfully transferred to the ALMN using a tension-free coaptation at 5.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75 cm from the radial styloid process. The nerve coaptation site was near the location of the palmar cutaneous nerve branching from the median nerve. There were landmarks for dissecting the ALMN at this location and at the coaptation site as well.\u003c/p\u003e\u003cp\u003eBased on the histological study, the LACN and ALMN had mean nerve diameters of 1733.54\u0026thinsp;\u0026plusmn;\u0026thinsp;484.44 \u0026micro;m and 1370.38\u0026thinsp;\u0026plusmn;\u0026thinsp;556.09 \u0026micro;m, respectively. The mean number of fascicles was 4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 and 3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9, with mean diameters of 406.09\u0026thinsp;\u0026plusmn;\u0026thinsp;210.47 \u0026micro;m and 634.23\u0026thinsp;\u0026plusmn;\u0026thinsp;247.74 \u0026micro;m, respectively.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRestoring sensory function in the hand is a prerequisite for restoring motor and active hand function, and thus, distal sensory nerve transfer complements motor reconstruction.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Significant disability can arise from a lack of sensation in important areas of the hand, such as the radial border of the index finger and the ulnar border of the thumb (supplied by the median nerve) or the ulnar border of the small finger (supplied by the ulnar nerve).\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn cases of median nerve injury, sensory loss is predominantly seen in the fingertips rather than the palm, and reinnervation via grafting was ineffective in a previous report.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e However, many nerve transfer procedures can restore sensory function in the hand. Ozkan et al.\u003csup\u003e3\u003c/sup\u003e used digital nerves from the middle, ring, or little finger, as well as the SRN, as donors for restoring sensation in the median nerve, specifically in the radial border of the index finger and ulnar border of the thumb. Their method was reliable, with improved hand function after the procedure, although the outcomes were dependent on timing, age, and patient education. Meanwhile, Brunelli used the SRN, the fourth common digital nerve, and the dorsal branch of the ulnar nerve as donors to the radial digital nerve of the index finger and ulnar digital nerve of the thumb, yielding satisfactory outcomes and restoration of protective pain sensation.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eNerve transfer for restoration of the median nerve sensation has previously been performed in patients with complete brachial plexus injury as well. The intercostal or intercostobrachial nerves have been used as donors to the lateral or medial cord in order to restore median nerve sensation. The studies of Ihara and Foroni resulted in favorable outcomes with good sensory intensity, whereas the study of Hattori resulted in limited hand sensibility but was nevertheless useful for activities of daily living.\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e The uncertain outcome caused by the nerve transfer, which does not directly coaptation to the median nerve and also involves proximal transfer, provided a poorer outcome than the distal transfer based on the principle of nerve regeneration.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe LACN is a pure sensory nerve that travels along the radial border of the forearm; its proximity to the median nerve makes it a suitable donor for median sensory restoration. The LACN is an expandable donor that is close to the recipient site, enabling direct coaptation to the sensory fascicle without tension or the need for an interposition nerve graft. In a previous study, LACN transfer was used to restore ulnar nerve sensation in adults with C8\u0026ndash;T1 brachial plexus injury and children with brachial plexus birth palsy, resulting in good protective sensation. \u003csup\u003e17\u0026ndash;19\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eIn the present study, the LACN served as the donor nerve to the ALMN, which provides the fascicle to the FCDN that provides sensation to the ulnar side of the thumb and radial side of the index finger. As confirmed by our dissection, the FCDN is reliably located on the anterolateral portion of the median nerve at the distal forearm level. Likewise, a previous study on the topography of the median nerve revealed that the sensory fascicle innervating the ulnar side of the thumb and radial side of the index finger is always found on the lateral side of the median nerve.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eWe demonstrated that the terminal branch of the LACN could be transferred to the median nerve using a tension-free coaptation at about 5 cm proximal to the radial styloid process. The similarities of the LACN and ALMN in terms of diameter and number of fascicles make them compatible. Based on the principles of nerve regeneration, nerve coaptation should be done as distally as possible with the shortest distance to facilitate nerve growth, and thus, we used the LACN at the distal forearm level.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eNo articles have reported complications of neuropathic pain or complaints of donor site morbidity after using LACN as a donor nerve.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Moreover, there is less sensory deficit seen at the donor site, which can be attributed to the superimposed innervation between the palmar cutaneous branch of the median nerve and LACN, as well as the interconnection and overlap between the LACN and SRN.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThis procedure has valuable clinical applications. Based on the anatomical study, this technique can be performed only at the distal forearm level. Thus, the natural cleavage plane and visual neurolysis could be leveraged for a faster surgical approach.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Even though the nerve coaptation was performed by the unilateral side of each index finger and thumb, the one-sided nerve repair of the palmar digital nerve ensures sensory recovery of the entire pulp.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e End-to-side coaptation of sensory nerve transfer is feasible in this technique. Similarly, Brown et al. demonstrated end-to-side reinnervation of the dorsal ulnar cutaneous nerve, which gradually improved sensory recovery.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe limitations of this study include a small sample size, and a large number of cadavers would be required to demonstrate the precise outcome, and some variation in the anatomy. The histological study of the axon count was not performed due to limitations of our equipment; however, the number of fascicles and size were matched between the two nerves. Furthermore, the study reported only the anatomical feasibility of the sensory nerve transfer; however, the clinical studies will be conducted in the future.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eLACN-to-ALMN transfer is a feasible procedure for sensory restoration, done using a tension-free coaptation at an average of 5 cm proximal to the radial styloid process. Additionally, the LACN and recipient site are also histologically compatible in terms of the diameter and number of fascicles. This technique is considered a treatment option for sensory restoration in patients with median nerve injury or neuropathy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committees of the Faculty of Medicine Ramathibodi Hospital, Mahidol University (MURA2021/717). We confirm that all methods were carried out in accordance with relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI declare that the authors have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received funding from the Faculty of Medicine Ramathibodi Hospital, Mahidol University\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eT.K. contributed to the conception, design of the work, investigation, and wrote the main manuscript. C.R. collected the data, investigation, analysis, interpretation, and wrote the manuscript. J.W. analysis and interpretation. I.W., T.T., and P.T. reviewed and revised the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFranco MJ, Nguyen DC, Phillips BZ, Mackinnon SE. Intraneural Median Nerve Anatomy and Implications for Treating Mixed Median Nerve Injury in the Hand. \u003cem\u003eHand (N Y)\u003c/em\u003e. 2016 Dec;11(4):416-420.\u003c/li\u003e\n\u003cli\u003eSchenck TL, Lin S, Stewart JK, et al. Sensory reanimation of the hand by transfer of the superficial branch of the radial nerve to the median and ulnar nerve. \u003cem\u003eBrain Behav\u003c/em\u003e. 2016;6(12):e00578.\u003c/li\u003e\n\u003cli\u003eOzkan T, Ozer K, Gulgonen A. Restoration of sensibility in irreparable ulnar and median nerve lesions with use of sensory nerve transfer: Long-term follow-up of 20 cases. \u003cem\u003eJ Hand Surg\u003c/em\u003e. 2001;26A:44-51.\u003c/li\u003e\n\u003cli\u003eMonz\u0026eacute;e J, Lamarre Y, Smith AM. The Effects of Digital Anesthesia on Force Control Using a Precision Grip. \u003cem\u003eJ Neurophysiol\u003c/em\u003e. 2003 Feb;89(2):672-83.\u003c/li\u003e\n\u003cli\u003eBrunelli GA. Sensory nerves transfers. \u003cem\u003eJ Hand Surg Br\u003c/em\u003e. 2004 Dec;29(6):557-62.\u003c/li\u003e\n\u003cli\u003eDun S, Kaufmann RA, Li ZM. Lower median nerve block impairs precision grip. \u003cem\u003eJ Electromyogr Kinesiol\u003c/em\u003e. 2007 Jun;17(3):348-54.\u003c/li\u003e\n\u003cli\u003eBertelli JA, Ghizoni MF. Very distal sensory nerve transfers in high median nerve lesions. \u003cem\u003eJ Hand Surg Am\u003c/em\u003e. 2011 Mar;36(3):387-93.\u003c/li\u003e\n\u003cli\u003eBertelli JA. Distal sensory nerve transfer in lower-type injuries of the brachial plexus. \u003cem\u003eJ Hand Surg Am\u003c/em\u003e. 2012 Jun;37(6):1194-9.\u003c/li\u003e\n\u003cli\u003eMoore AM, Franco M, Tung TH. Motor and Sensory Nerve Transfers in the Forearm and Hand. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e. 2014 Oct;134(4):721-730.\u003c/li\u003e\n\u003cli\u003eDuraku LS, Hundepool CA, Moore AM, et al. Sensory nerve transfers in the upper limb after peripheral nerve injury: a scoping review. \u003cem\u003eJ Hand Surg Eur\u003c/em\u003e. 2024;49(8):946-955.\u003c/li\u003e\n\u003cli\u003ePlanitzer U, Steinke H, Meixensberger J, Bechmann I, Hammer N, Winkler D. Median nerve fascicular anatomy as a basis for distal neural prostheses. \u003cem\u003eAnn Anat\u003c/em\u003e. 2014;196:144-149.\u003c/li\u003e\n\u003cli\u003eSoubeyrand M, Melhem R, Protais M, Artuso M, Creze M. Anatomy of the median nerve and its clinical applications. \u003cem\u003eHand Surg Rehabil\u003c/em\u003e. 2020 Feb;39(1):2-18.\u003c/li\u003e\n\u003cli\u003eBrown JM, Yee A, Mackinnon SE. Distal median to ulnar nerve transfer to restore ulnar motor and sensory function within the hand: technical nuances. \u003cem\u003eNeurosurgery\u003c/em\u003e. 2009;65(5):966-77.\u003c/li\u003e\n\u003cli\u003eIhara K, Doi K, Sakai K, Kuwata N, Kawai S. Restoration of sensibility in the hand after complete brachial plexus injury. \u003cem\u003eJ Hand Surg Am\u003c/em\u003e. 1996 May;21(3):381-6.\u003c/li\u003e\n\u003cli\u003eForoni L, Siqueira MG, Martins RS, Heise CO, Neto HS, Imamura AY. Good sensory recovery of the hand in brachial plexus surgery using the intercostobrachial nerve as the donor. \u003cem\u003eArq Neuropsiquiatr\u003c/em\u003e. 2017 Nov;75(11):796-800.\u003c/li\u003e\n\u003cli\u003eHattori Y, Doi K, Sakamoto S, Yukata K. Sensory Recovery of the Hand with Intercostal Nerve Transfer following Complete Avulsion of the Brachial Plexus. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e. 2009 Jan;123(1):276-283.\u003c/li\u003e\n\u003cli\u003eOberlin C, Teboul F, Severin S, Beaulieu JY. Transfer of the lateral cutaneous nerve of the forearm to the dorsal branch of the ulnar nerve, for providing sensation on the ulnar aspect of the hand. \u003cem\u003ePlast Reconstr Surg\u003c/em\u003e. 2003 Oct;112(5):1498-50.\u003c/li\u003e\n\u003cli\u003eRuchelsman DE, Price AE, Valencia H, Ramos LE, Grossman John AI. Sensory restoration by lateral antebrachial cutaneous to ulnar nerve transfer in children with global brachial plexus injuries. \u003cem\u003eHand (N Y)\u003c/em\u003e. 2010 Dec;5(4):370-3.\u003c/li\u003e\n\u003cli\u003ePauchot J, Assouline U, Valmary-Degano S, Constantinou B, Obert L, Lepage D. Transfer of the lateral antebrachial cutaneous nerve to the dorsal branch of the ulnar nerve without nerve graft in case of lower brachial plexus injuries: Anatomical and feasibility study. \u003cem\u003eHand Surg Rehabil\u003c/em\u003e. 2017 Sep;36(4):296-300.\u003c/li\u003e\n\u003cli\u003ePaulin E, Bowen EC, Dogar S, et al. A comprehensive review of topography and axon counts in upper-extremity peripheral nerves: A guide for neurotization. \u003cem\u003eJ Hand Surg GO\u003c/em\u003e. 2024;6(2024):784-795.\u003c/li\u003e\n\u003cli\u003eKanchanathepsak T, Rojpitipongsakorn C, Tawonsawatruk T, Suppaphol S, Watcharananan I, Tuntiyatorn P. The Lateral Antebrachial Neurocutaneous Flap: A Cadaveric Study and Clinical Applications. \u003cem\u003eJ Reconstr Microsurg\u003c/em\u003e. 2020 Sep;36(7):541-548.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lateral antebrachial cutaneous nerve, Median sensory restoration, Nerve transfer, Sensory restoration","lastPublishedDoi":"10.21203/rs.3.rs-7646302/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7646302/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Median nerve injuries can result in substantial functional deficits with both motor and sensory components. Sensory loss results in impaired hand function. The most important areas are the ulnar and radial aspects of the thumb and index finger, respectively. This study aimed to evaluate the feasibility of nerve transfer from the lateral antebrachial cutaneous nerve (LACN) to the median nerve for restoring hand sensation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This study used 16 cadaveric upper limbs. After dissecting the LACN and its branches, the length and size were recorded. The median nerve was identified via mid-palm and intra-fascicular dissection back from the first common digital nerve (FCDN) to the anterolateral fascicles of the median nerve (ALMN) at the distal forearm level. The simulated nerve transfer was performed. The coaptation site was measured with reference to the radial styloid (RS). Nerve stumps from the coaptation site were histologically examined.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Twelve formalin-preserved and four fresh-frozen cadavers were dissected with a mean age of 72.3 ± 20.3 years. Measured from the RS, the mean coaptation site was 5.72 ± 1.75 cm. The mean diameters of the LACN and ALMN were 1733.54 ± 484.44 µm and 1370.38 ± 556.09 µm, respectively. The LACN and ALMN had a mean number of 4 ± 1.8 and 3.4 ± 1.9 fascicles, respectively, with mean fascicular diameters of 406.09 ± 210.47 µm and 634.23 ± 247.74 µm.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e LACN-to-ALMN transfer is feasible using a tension-free coaptation at around 5 cm from the RS. The LACN and recipient site are histologically compatible in terms of the diameter and number of fascicles. This transfer technique can be used to restore important areas of hand sensation in cases of median nerve injury or neuropathy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical relevance: \u003c/strong\u003eThis study proposes anatomical and histological insights into the nerve transfer for sensory restoration of the median nerve\u003c/p\u003e","manuscriptTitle":"The feasibility of the lateral antebrachial cutaneous nerve transfer for median sensory restoration: A cadaveric study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 08:54:58","doi":"10.21203/rs.3.rs-7646302/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-11-26T23:24:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-13T11:59:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241122105944331240417416560904825960505","date":"2025-10-13T08:19:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-12T09:47:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-12T09:47:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-07T12:43:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2025-10-06T06:21:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3408ba81-8129-4ddc-aa35-f2b2002194e5","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-29T16:06:24+00:00","versionOfRecord":{"articleIdentity":"rs-7646302","link":"https://doi.org/10.1186/s13018-025-06567-5","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2025-12-28 15:58:27","publishedOnDateReadable":"December 28th, 2025"},"versionCreatedAt":"2025-10-08 08:54:58","video":"","vorDoi":"10.1186/s13018-025-06567-5","vorDoiUrl":"https://doi.org/10.1186/s13018-025-06567-5","workflowStages":[]},"version":"v1","identity":"rs-7646302","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7646302","identity":"rs-7646302","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}