01911nas a2200313   4500000000100000008004100001260001300042653001500055653001000070653001000080653001100090653003100101653001100132653001200143653000900155653001700164653001600181653001400197653001700211653002000228653001600248100001900264700001100283245006500294300001000359490000700369520120700376022001401583       1984                            d  c1984 Mar10aAdolescent10aAdult10aChild10aFemale10aHand Deformities, Acquired10aHumans10aleprosy10aMale10aMedian Nerve10aMiddle Aged10aParalysis10aRadial Nerve10aTendon Transfer10aUlnar nerve1 aSundararaj G D1 aMani K00aSurgical reconstruction of the hand with triple nerve palsy.  a260-40 v663 a<p>Simultaneous paralysis of the ulnar, median and radial nerves is seen in about 1% of hands with nerve involvement in Hansen's disease. Forty such cases were treated between 1955 and 1976; 35 of these have been followed up. In two hands there was a high radial, median and ulnar palsy and these left no scope for reconstruction. The other 33 cases which underwent two-stage reconstructive surgery are presented here. The first stage consisted of restoring active extension of the wrist, fingers and thumb: for this purpose the ideal muscles for transfer are pronator teres, flexor carpi radialis and palmaris longus respectively, and muscle power exceeding Grade 3 (on the MRC classification) was achieved in 89%, 96%, and 100% of these individual transfers. Arthrodesis of the wrist is not recommended when suitable muscles are available for transfer. The second stage of reconstruction attempts to restore intrinsic function of the fingers and opposition of the thumb; the sublimis is ideal for both purposes and satisfactory restoration of function was achieved in 89% and 85% of cases respectively. Ten of the 18 hands in which all five tendons were transferred had good or excellent results.</p>  a0301-620X