Reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap in a teenager

A case report and literature review

Diogo Casal, Diogo Pais, Eduarda Mota-Silva, Giovanni Pelliccia, Inês Iria, Paula A Videira, Maria Manuel Mendes, João Goyri-O'Neill, Maria Manuel Mouzinho

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

There is evidence that nerve flaps are superior to nerve grafts for bridging long nerve defects. Moreover, arterialized neurovenous flaps (ANVFs) have multiple potential advantages over traditional nerve flaps in this context. This paper describes a case of reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap and presents a literature review on this subject. A 16-year-old boy sustained a stab wound injury to the medial aspect of the distal third of his right forearm. The patient was initially observed and treated at another institution where the patient was diagnosed with a flexor carpis ulnaris muscle and an ulnar artery section. The artery was ligated and the muscle was sutured. Four months later, the patient was referred to our institution with complaints of ulnar nerve damage, as well as hand pain and cold intolerance. Physical examination and ancillary tests supported the diagnosis of ulnar artery and nerve complete section. Surgery revealed an 8 cm hiatus of the ulnar artery and a 5 cm defect of the ulnar nerve. These gaps were bridged with a flow through ANVF containing the sural nerve and the lesser saphenous vein. The postoperative course was uneventful. Two years postoperatively, the patient had regained normal trophism and M5 strength in all previously paralyzed muscles according to the Medical Research Council Scale. Thermography revealed good perfusion in the right ulnar angiosome. The ANVF may be an expedite, safe and efficient option to reconstruct a long ulnar nerve and artery defect.

Original languageEnglish
Pages (from-to)209-217
JournalMicrosurgery
Volume38
Issue number2
Early online date2 Nov 2017
DOIs
Publication statusPublished - Feb 2018

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Ulnar Artery
Ulnar Nerve
Free Tissue Flaps
Muscles
Stab Wounds
Sural Nerve
Saphenous Vein
Forearm
Physical Examination
Biomedical Research
Hand
Arteries
Perfusion
Transplants
Pain
Wounds and Injuries

Keywords

  • HAND
  • INJURIES
  • REPAIR
  • SURGERY
  • GRAFTS

Cite this

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abstract = "There is evidence that nerve flaps are superior to nerve grafts for bridging long nerve defects. Moreover, arterialized neurovenous flaps (ANVFs) have multiple potential advantages over traditional nerve flaps in this context. This paper describes a case of reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap and presents a literature review on this subject. A 16-year-old boy sustained a stab wound injury to the medial aspect of the distal third of his right forearm. The patient was initially observed and treated at another institution where the patient was diagnosed with a flexor carpis ulnaris muscle and an ulnar artery section. The artery was ligated and the muscle was sutured. Four months later, the patient was referred to our institution with complaints of ulnar nerve damage, as well as hand pain and cold intolerance. Physical examination and ancillary tests supported the diagnosis of ulnar artery and nerve complete section. Surgery revealed an 8 cm hiatus of the ulnar artery and a 5 cm defect of the ulnar nerve. These gaps were bridged with a flow through ANVF containing the sural nerve and the lesser saphenous vein. The postoperative course was uneventful. Two years postoperatively, the patient had regained normal trophism and M5 strength in all previously paralyzed muscles according to the Medical Research Council Scale. Thermography revealed good perfusion in the right ulnar angiosome. The ANVF may be an expedite, safe and efficient option to reconstruct a long ulnar nerve and artery defect.",
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Reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap in a teenager : A case report and literature review. / Casal, Diogo; Pais, Diogo; Mota-Silva, Eduarda; Pelliccia, Giovanni; Iria, Inês; Videira, Paula A; Mendes, Maria Manuel; Goyri-O'Neill, João; Mouzinho, Maria Manuel.

In: Microsurgery, Vol. 38, No. 2, 02.2018, p. 209-217.

Research output: Contribution to journalArticle

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AU - Pais, Diogo

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AU - Pelliccia, Giovanni

AU - Iria, Inês

AU - Videira, Paula A

AU - Mendes, Maria Manuel

AU - Goyri-O'Neill, João

AU - Mouzinho, Maria Manuel

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AB - There is evidence that nerve flaps are superior to nerve grafts for bridging long nerve defects. Moreover, arterialized neurovenous flaps (ANVFs) have multiple potential advantages over traditional nerve flaps in this context. This paper describes a case of reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap and presents a literature review on this subject. A 16-year-old boy sustained a stab wound injury to the medial aspect of the distal third of his right forearm. The patient was initially observed and treated at another institution where the patient was diagnosed with a flexor carpis ulnaris muscle and an ulnar artery section. The artery was ligated and the muscle was sutured. Four months later, the patient was referred to our institution with complaints of ulnar nerve damage, as well as hand pain and cold intolerance. Physical examination and ancillary tests supported the diagnosis of ulnar artery and nerve complete section. Surgery revealed an 8 cm hiatus of the ulnar artery and a 5 cm defect of the ulnar nerve. These gaps were bridged with a flow through ANVF containing the sural nerve and the lesser saphenous vein. The postoperative course was uneventful. Two years postoperatively, the patient had regained normal trophism and M5 strength in all previously paralyzed muscles according to the Medical Research Council Scale. Thermography revealed good perfusion in the right ulnar angiosome. The ANVF may be an expedite, safe and efficient option to reconstruct a long ulnar nerve and artery defect.

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