Resumen
Las lesiones proximales completas del nervio mediano son infrecuentes y este caso se describió en nuestro trabajo original.¹ Después del injerto de nervio safeno externo, el paciente fue controlado durante 36 meses; se presentan la progresión del signo de Tinel, la función motriz, sensitiva y autonómica, además de los hallazgos electromiográficos. La velocidad promedio de reinervación a lo largo del tiempo fue de 0.7 mm/día, aproximadamente, a pesar de la avanzada edad del paciente (80 años). Las fibras sensoriales y pequeñas alcanzaron primero el pulpejo del dedo índice. El patrón de reinervación motriz siguió la distribución típica del flexor largo del pulgar, pero la aparición temprana de grandes unidades motoras en el músculo pronador cuadrado y el abductor del pulgar no fue clara. El dolor es una característica constante, y provoca una sensación dolorosa "fría" permanente en la mano y un dolor neuropático punzante en la distribución del nervio mediano. A pesar del progreso favorable de la reinervación, el paciente informó escasa recuperación funcional.

Palabras clave
Lesión proximal del nervio mediano, regeneración, evolución funcional, dolor

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Abstract
Proximal complete median nerve lesions are rare, and this case has been described in our original paper.¹ After the sural nerve graft, the patient was followed for 36 months and the progression of Tinel sign, the motor and sensory and autonomic function in addition to EMG findings are presented. The speed of reinnervation averaged over time was approximately 0.7 mm/day, despite the old age (80 years) of the patient. Sensory and small fibres reached the tip of the index finger first. The motor reinnervation pattern followed the typical pattern for the long flexor of the thumb, but early appearance of large motor units in the pronator quadratus muscle and abductor pollicis muscle remained unclear. Pain is a constant feature, resulting in a permanent painful "cold" feeling in the hand and an intermittent neuropathic shooting pain in median nerve distribution. Despite the favourable progress of reinnervation, little functional recovery according to the patients view has occurred.Proximal complete median nerve lesions are rare, and this case has been described in our original paper.¹ After the sural nerve graft, the patient was followed for 36 months and the progression of Tinel sign, the motor and sensory and autonomic function in addition to EMG findings are presented. The speed of reinnervation averaged over time was approximately 0.7 mm/day, despite the old age (80 years) of the patient. Sensory and small fibres reached the tip of the index finger first. The motor reinnervation pattern followed the typical pattern for the long flexor of the thumb, but early appearance of large motor units in the pronator quadratus muscle and abductor pollicis muscle remained unclear. Pain is a constant feature, resulting in a permanent painful "cold" feeling in the hand and an intermittent neuropathic shooting pain in median nerve distribution. Despite the favourable progress of reinnervation, little functional recovery according to the patients view has occurred.

Key words
Proximal median nerve lesion, regeneration, functional outcome, pain

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