Schwannomas are the most common benign tumors developing in peripheral nerves. They account for 5% of all tumors in upper extremity. They usually present as a slow-growing mass, sometimes associated to pain and paresthesia. Preoperative evaluation is based on US and MRI, but final diagnosis requires histopathology. The aim of this study is to define clinical findings and MRI characteristics in identification, localization, and possible differential diagnosis of schwannomas.

When approaching a palpable mass in the upper limbs, the possibility of a peripheral nerve tumour should always be considered. It is important to look for typical signs of schwannomas, such as a positive Tinel sign and peripheral paraesthesia. Imaging assessment with magnetic resonance imaging (MRI) and ultrasonography enables the determination of where the tumour takes its origin and from which nerve. Microsurgical techniques and know-how are recommended in approaching the resection in order to respect as many nerve fibres as possible.

The anterolateral thigh flap was thin enough for defects on the dorsum and/or palm of the hand and for first web reconstruction after scar contracture release. It has many advantages in free flap surgery including a long pedicle with a suitable vessel diameter, and the donor-site morbidity is acceptable. The thin anterolateral thigh flap is a versatile soft-tissue flap that achieves good hand contour with low donor-site morbidity.