MORPHOMETRIC STUDY OF THIRD WEB SPACE BRANCH OF MEDIAN NERVE: ITS CLINICAL IMPLICATIONS ON NERVE GRAFTING Raviprasanna.K.H * 1 , Anand L Kulkarni 2 , Aditya Krishna Das 3 . *1 Assistant   Professor, Department of Anatomy, Sree Narayana Institute of Medical Sciences, North Kuthiathode, Chalakka, Ernakulam, Kerala, India. 2  Professor and Head, Department of Anatomy, Sree Narayana Institute of Medical Sciences, North Kuthiathode, Chalakka, Ernakulam, Kerala, India. 3  Assistant   Professor, Department of Anatomy, Sree Narayana Institute of Medical Sciences, North Kuthiathode, Chalakka, Ernakulam, Kerala, India. Address   for   correspondence:   Dr.   Raviprasanna.   K.   H,   Assistant   Professor,   Department   of   Anatomy,   Sree   Narayana   Institute   of   Medical   Sciences,   North Kuthiathode, Chalakka, Ernakulam, Kerala-683594. Phone no- +919496752619 Fax No- 91484-2478093. E-Mail:  pravi_kh81@yahoo.in / pravikh8124@gmail.com ABSTRACT Background:   Nerve   injuries   are   more   common   in   superior   extremities   because   of   trauma   and   can   lead   to   motor   &   sensory   deficits   and   development   of intractable   pain.   Cutaneous   nerves   can   be   harvested   for   grafting   to   bridge   the   gap   created   by   injuries.   Purpose   of   the   study :   To   know   the   available   length   of third webspace branch of median nerve for nerve grafting. Materials   and   Methods:   The   study   included   33   human   cadaver   upper   limb   specimens   from   Department   of   Anatomy,   Sree   Narayana   Institute   of   Medical Sciences,   Ernakulam.   The   specimens   were   fixed   with   10%   neutral   buffered   formalin   solution   and   the   third   webspace   branch   of   median   nerve   was measured. Results:   In   the   present   study   we   observed   that   the   mean   length   available   for   grafting   from   distal   end   of   flexor   retinaculum   to   the   webspace   is   6.45   cm   with the range of 4.5 cm to 7.57 cm. Conclusion:   The   present   study   has   revealed   the   length   of   third   webspace   branch   of   median   nerve   which   can   be   used   for   bridging   the   gap   in   ulnar   nerve injury in the hand or median nerve injury in 1 st  webspace. KEY WORDS: Median nerve, Grafting, Peripheral nerve injuries, Webspace. References 1 . Kouyoumdjian JA. Peripheral nerve injuries: a retrospective survey of 456 cases. Muscle & Nerve, 2006;34(6):785-788. 2 . Siemionow M, Brzezicki G. Current techniques and concepts in peripheral nerve repair. International Review of Neurobiology, 2009;87(C):141-172. 3 . Thomson   JG.   Median   and   ulnar   nerve   injuries:   A   meta-analysis   of   predictors   of   motor   and   sensory   recovery   after   modern   microsurgical   nerve   repair: Discussion. Plastic and Reconstructive Surgery, 2005;116(2):495-496. 4 . Brushart   TME.   The   mechanical   and   humoral   control   of   specificity   in   nerve   repair.   In   Operative   Nerve   Repair.   R.H.Gelberman,   Ed.,   JB   Lippincott, Philadelphia, PA, USA;1991:215-230. 5 . Scholz   T,   Krichevsky   A,   Sumarto   A,   Jaffurs   D,   Wirth   GA,   Paydar   K,   Evans   G.   Peripheral   nerve   injuries:   an   international   survey   of   current   treatments   and future perspectives. J Reconstr Microsurg. 2009;25(6):339–44. 6 . Rosberg   HE,   Carlsson   KS,   Hojgard   S,   Lindgren   b,   Lundborg   g,   Dahlin   LB.   Injury   to   the   human   median   and   ulnar   nerves   in   the   forearm--analysis   of   costs for treatment and rehabilitation of 69 patients in southern Sweden. J Hand Surg (br) 2005;30:35-39. 7 . Dahlin LB. Techniques of peripheral nerve repair. Scandinavian Journal of Surgery, 2008;97:310-316. 8 . Mackinnon SE , Colbert SH . Nerve transfers in the hand and upper extremity surgery . Tech Hand up Extreme Surg.  2008 Mar;12(1):20-33. 9 . David J Sultsky. A Practical Approach to Nerve grafting in the upper extremity. Atlas of the Hand Clinics. 2005;(10):73-92. 1 0 . Higgins   JP,   Fisher   S,   Serletti   JM,   Orlando   GS .   Assessment   of   nerve   graft   donor   sites   used   for   reconstruction   of   traumatic   digital   nerve   defects.   J   Hand Surg [Am] 2002;27:286-92. 1 1 . Ross   D ,   Mackinnon   SE ,   Chang   YL .   Intraneural   anatomy   of   the   median   nerve   provides   "third   web   space"   donor   nerve   graft.   J   Reconstr   Microsurg.    1992 May;8(3):225-32. 1 2 . Tung TH, Mackinnon SE. Nerve transfers: Indications, techniques, and outcomes. J Hand Surg Am. 2010;35:332–341. 13. Amy M. Moore, Michael Franco, Thomas H Tung. Motor and sensory nerve transfers in the forearm and hand. Hand/Peripheral nerve. Plastic and reconstructive surgery. October 2014;134(4):721-730.