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ISSN 1405-0625 (Print)

2026, Number 2

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Cir Plast 2026; 36 (2)

Correction of claw hand using modified Brand technique and nerve repair: case series

Velázquez-Mujica J, Chi-Chen H, Ruiz-Santos BM, Vargas-De LE, Catuar-Montero MA, Gutiérrez-Fernández SE, Quintanar-Bravo BA

Language: Spanish
References: 17
Page: 143-148
PDF size: 1432.51 Kb.


ABSTRACT

The aim of this study was to evaluate functional and aesthetic outcomes of claw hand correction using a modified Brand technique combined with neuroma resection and autologous sural nerve grafting in patients with chronic post-traumatic ulnar paralysis. Nine patients treated between 2019 and 2021 with complete ulnar nerve injury and neuroma were included. They underwent neuroma resection, sural nerve grafting and modified Brand tendon transfer, using either the plantaris tendon or, when absent, extensor tendons of the toes. Grip strength was assessed using a Jamar dynamometer, and function was evaluated with the DASH (Disabilities of the Arm, Shoulder and Hand) score before and after surgery. Grip strength improved from 19.6 ± 3.9 to 29.0 ± 2.2 kg (p < 0.05), and DASH scores improved from 55.9 ± 10.8 to 34.3 ± 5.9. Sensory recovery occurred between six and nine months without major complications. The modified Brand technique with nerve grafting is safe, reproducible, and effective for restoring function and aesthetics in chronic ulnar paralysis with neuroma.


REFERENCES

  1. Bouvier M. Note sur une paralysie partielle des muscles de la main. Bull Acad Nat Med (Paris) 1851; 18: 125-139.

  2. Sammer DM, Chung KC. Tendon transfers: part II. Transfers for ulnar nerve palsy and median nerve palsy. Plast Reconstr Surg 2009; 124 (3): 212e-221e. doi: 10.1097/PRS.0b013e3181b037c7.

  3. Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. Alteration of neuroma formation by manipulation of its microenvironment. Plast Reconstr Surg 1985; 76 (3): 345-353.

  4. Vernadakis AJ, Koch H, Mackinnon SE. Management of neuromas. Clin Plast Surg 2003; 30 (2): 247-268. doi: 10.1016/S0094-1298(02)00104-9.

  5. Sapienza A, Green S. Correction of the claw hand. Hand Clin 2012; 28 (1): 53-66. doi: 10.1016/j.hcl.2011.09.009.

  6. Ebenezer M, Rao K, Partheebarajan S. Factors affecting functional outcome of surgical correction of claw hand in leprosy. Indian J Lepr 2012; 84: 259-264.

  7. Gottschalk P, Bindra RR. Late reconstruction of ulnar nerve palsy. Orthop Clin North Am 2012; 43 (4): 495-507. doi: 10.1016/j.ocl.2012.08.001.

  8. Taylor NL, Raj D, Dick HM, Solomon S. The correction of ulnar claw fingers: a follow-up study comparing the extensor-to-flexor with the palmaris longus four-tailed tendon transfer in patients with leprosy. J Hand Surg Am 2004; 29 (4): 595-604.

  9. Ozkan T, Ozer K, Gulgonen A. Three tendon transfer methods in reconstruction of ulnar nerve palsy. J Hand Surg Am 2003; 28 (1): 35-43.

  10. Ratner JA, Peljovich A, Kozin SH. Update on tendon transfers for peripheral nerve injuries. J Hand Surg Am 2010; 35 (8): 1371-1381. doi: 10.1016/j.jhsa.2010.05.023.

  11. Sachar K. Reconstruction for ulnar nerve palsy. In: Berger RA, Weiss AP, editors. Hand Surgery. Philadelphia: Lippincott Williams & Wilkins; 2004. pp. 979-990.

  12. Leinberry CF, Wehbe MA. Brachial plexus anatomy. Hand Clin 2004; 20 (1): 1-5.

  13. Kerver AL, Carati L, Eilers PH, Langezaal AC, Kleinrensink GJ, Walbeehm ET. An anatomical study of the ECRL and ECRB: Feasibility of developing a preoperative test for evaluating the strength of the individual wrist extensors. J Plast Reconstr Aesthet Surg 2013; 66 (4): 543-550. doi: 10.1016/j.bjps.2012.12.015.

  14. Blackmore S, Williams D, Wolf S. The use of biofeedback in hand rehabilitation. In: Mackin E, Callahan A, Schneider L, Skirven T, editors. Rehabilitation of the hand and upper extremity. 5th ed. Vol. 2. St. Louis: Mosby; 2002. pp. 1745-1763.

  15. Bhargava AS, Eapen C, Kumar SP. Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis- comparison of involved vs. uninvolved side in athletes and non-athletes. Sports Med Arthrosc Rehabil Ther Technol 2010; 2: 22. doi: 10.1186/1758-2555-2-22.

  16. Citron N, Taylor J. Tendon transfer in partially unaesthetic hands. J Hand Surg Br 1987; 12 (1): 14-18.

  17. Omer GE Jr. Tendon transfer in combined nerve lesion. Orthop Clin North Am 1974; 5 (2): 377-387.




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