• Melody Goncalves, Georges Pfister, Emma Abecidan, Claire Redais, Alexia Milaire, Zoubir Belkheyar, and Laurent Mathieu.
• Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, Clamart, France.
• World Neurosurg. 2024 Oct 1; 190: e1124e1129e1124-e1129.

ObjectiveThe aim of this study is to determine the maximum loss of median and ulnar nerve substances that can be treated by direct suture in elbow flexion and to quantify this elbow flexion. The other objective is to determine the participation of the wrist position in this direct suture in elbow flexion.MethodsWe performed an experimental study on 6 ulnar nerve lesions and 6 median nerve lesions. For each defect, a direct tensionless suture was performed with elbow flexion and in three different positions of the wrist (wrist extension, neutral position, and wrist flexion).ResultsA 90° elbow flexion allowed direct suturing of defects up to 40 mm in the 3 positions of the wrist. A bowstringing effect (i.e., increase of the perpendicular distance of the nerve from the axis of rotation of the elbow) was noted starting from 25 mm of nerve defect. Wrist extension placed tension on the nerve suture for both nerves.ConclusionsThe results of this first anatomical study clarified the conditions for direct suturing of ulnar and median nerve defects in the flexed elbow position and flexed wrist position. This is an approach to consider for limited nerve defects to the elbow or when allograft harvesting is to be avoided.Copyright © 2024 Elsevier Inc. All rights reserved.

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