Proximal Ulnar Nerve Reconstruction with Interposition Sural Nerve Grafting and Distal Supercharged AIN Transfer

High ulnar nerve injuries are associated with poor functional prognosis due to the long regenerative distance required to reach the intrinsic hand muscles. The prolonged denervation time often leads to irreversible muscle fibrosis before native axons can regenerate. We present the case of a 40-year-old male with symptomatic ulnar nerve neuroma and complete ulnar palsy following a traumatic elbow laceration. Management involved a dual-pathway approach: proximal excision of the neuroma with a 24-cm sural nerve autograft and a concomitant distal supercharged end-to-side transfer of the anterior interosseous nerve (AIN) to the deep motor branch of the ulnar nerve. This technique facilitates immediate “supercharged” of the distal motor endplates via the AIN transfer while allowing for long-term reinnervation through the proximal graft. Combining proximal reconstruction with distal supercharging addresses the “time vs. distance” constraint in high nerve injuries, potentially improving intrinsic muscle salvage.