An important point in paraplegic is the prevention of the pressure ulcers. The main etiologic factor in the development of the ulcers is the absence of protective sensation. We describe a new treatment to restore the sensation in paraplegics, using end-to-side neurorraphies. Method: Two patients were submitted to two sural nerve grafts bridging intercostals nerves above the spinal cord lesion level and sciatic nerve in the buttock area, bilateral, using end-to-side neurorraphies. The first patient, 74 years old, had anesthesia bellow T10, resultant of spinal cord lesion at L4 12 years ago. He developed pressure ulcers in ischiadic and buttock area. Four years ago he was submitted to the nerve grafts described above. He presented progressive gain of sensation evaluated by the Semmes-Weinstein monofilaments test pre and post-op. Now he has sensation to 2 g from T10 to L1 and to 300 g in L2 and L3 area. The second patient, 50 years old, had a sequelae of a spinal cord lesion at T8 - T9, 20 years ago. He had pressure ulcers and was submitted to three surgeries with cutaneous and myocutaneous flaps. Pre-op. evaluation showed sensation only above T10. He was submitted 3 years ago to sural nerve grafts as described above. He presented pain during one year and progressive recovery of sensation. Now he refers 2 g in T10, 4 g in T11 and 300 g in T12. Another interesting find is that the patient now feels bladder fullness. The two patients did not present pressure ulcers anymore. Although the small number of patients the positive result in both cases indicates that this technique could be a good alternative in this arduous field. Conclusion: Sural nerve grafts bridging intercostal and sciatic nerves using the end-to-side neurorraphies were efficient to restore sensation in two paraplegic patients.
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