Clinical Outcomes and Prognostic Factors of Median and Ulnar Nerve Grafts: A 10-Year Retrospective Study

Abstract

Background/Objectives: Peripheral nerve injuries of the median and ulnar nerves frequently cause significant functional impairment in young patients. When primary repair is not possible, autologous sural nerve grafting remains the gold-standard reconstructive technique, although functional outcomes remain variable and often unpredictable. This study aimed to evaluate functional outcomes after sural nerve autografting for median and/or ulnar nerve defects and to identify factors associated with sensory and motor recovery. Methods: A retrospective case series was conducted on all patients who underwent autologous sural nerve grafting for median and/or ulnar nerve defects between 2016 and 2025, with a minimum follow-up of 12 months. Vascularized and partial nerve grafts, as well as brachial plexus or terminal branch injuries, were excluded. Functional recovery was assessed using the British Medical Research Council (BMRC) sensory and motor scales, and outcomes were classified as good, fair, or bad. Univariate analysis was performed to identify factors associated with functional outcomes. Results: Forty-three patients received 50 nerve grafts (mean follow-up: 30 months). Good sensory recovery (≥S3) was achieved in 80% of median and 52% of ulnar nerve grafts, while good motor recovery (≥M3) was observed in 48% and 32% of cases, respectively. Motor recovery was significantly better for median than ulnar nerve injuries. Factors significantly associated with recovery included patient age, injury type (isolated vs. combined), associated vascular injury, time to surgery, defect length, and number of cable grafts. Conclusions: Sural nerve autografting provides satisfactory functional outcomes, particularly for sensory recovery and median nerve defects, while motor recovery remains limited in ulnar and combined injuries. Early surgery, shorter defects, and adequate cable grafting may improve prognosis.