The patient a Yemeni citizen from Hadramout was operated by me 31-July-2002 and sural nerve graft was bridged with the phrenic and the right intercostal nerves first and second to the median nerve. The patient showed considerable improvement of the deltoid, biceps brachii and the group of median nerve with sensation. The ulnar nerve still not functioning because it was not included with the repair. The patient then came came to the clinic 06-August-2003 with EMG done the same day confirming non-function of the ulnar nerve.

On examination, the patient have good power of the right deltoid, biceps brachii and function of the right musculocutaneous nerve, good sensation of the median distribution with weak functions of the distal elements of the median nerve with absence of the function of the ulnar nerve.

Considering that the first surgery gave unexpected positive results a second surgery was advised to augment the function of the ulnar nerve. Incision supraclavicular and exposure of the all the functioning branches of the right brachial plexus, which were not violated during first surgery. The suprascapular, the thoracodorsal and lateral anterior thoracic nerves were identified and dissected and check by stimulation. Through separate incision, the ulnar nerve was identified and followed up to the lower trunk to reach maximum to  lower cord and there was bisected. The three harvested nerves from the upper and medial cord of the right brachial plexus were gathered with stitch and direct anastamoses was achieved with the big lower trunk and good adaptation was achieved.  Routine closure of the wounds.

Smooth postoperative recovery. She was sent to the ward.

The patient came to the clinic 08-Sptember-2004 telling that sensation of the ulnar division took place, but the distal muscles still the same.

The patient then came 12-September-2004 telling that all sensation of the upper right limb normalized, but feeling that the motor activity is somewhat related with breathing.

The patient needs several years to recover even partially, but sensation is a major factor and the distal motor activity will improve to lesser extent.