Brachial artery perforator‐based propeller flap coverage for prevention of readhesion after ulnar nerve neurolysis

Abstract

It is difficult for most plastic and orthopaedic surgeons to treat nerve dysfunction related to neural adhesion because the pathophysiology and suitable treatment have not been clarified. In the current report, we describe our experience of surgical treatment for adhesive ulnar neuropathy. A 58-year-old male complained of pain radiating to the ulnar nerve-innervated area during elbow and wrist motion caused by adhesive ulnar neuropathy after complex open trauma of the elbow joint. The patient obtained a good clinical outcome by surgical neurolysis of the ulnar nerve combined with a brachial artery perforator-based propeller flap to cover the soft tissue defect after resection of the scar tissue and to prevent readhesion of the ulnar nerve. This flap may be a useful option for ulnar nerve coverage after neurolysis without microvascular anastomosis in specific cases.

Use of Indocyanine Green Imaging for Perforator Identification in Preexpanded Brachial Artery Perforator Flaps

“…15,[22][23][24][25][26] The majority of the existing literature on BAP flap has revolved around the use of handheld Doppler ultrasound to identify the perforators of the medial arm. 2,[8][9][10]27 However, our clinical experience echoes recent reports in the literature that challenge the utility of Doppler in this area as differentiating signals of the brachial artery from that of its perfo-rators can be difficult. 1,14,28,29 Color duplex ultrasonography allows for direct visualization of the vascular anatomy, but it can be time-intensive, particularly for intraoperative use, and requires a relatively steep learning curve.…”

Application of free temporoparietal fascial flap for recurrent neural adhesion of superficial radial nerve—A case report

“…In this case we decided to choose alternative treatment because there was no obvious neuroma of the superficial radial nerve and was much scar tissue entire forearm area including brachioradialis muscle. Because neurolysis alone has a lower success rate for recurrent neural adhesion, several surgeons have recommended additional preventive procedures, including coatings with alginate sol, hyaluronic acid and carboxymethylcellulose, wrapping with an autologous vein, and covering with an adipofascial flap . It is thought that the adipofascial flap is especially effective for providing a nerve gliding surface, buffering compression, and accelerating nerve healing via an abundant blood supply .…”

“…Because neurolysis alone has a lower success rate for recurrent neural adhesion, 1,12,15 several surgeons have recommended additional preventive procedures, including coatings with alginate sol, 16 hyaluronic acid and carboxymethylcellulose, 17 wrapping with an autologous vein, 12,15 and covering with an adipofascial flap. 11,18,19 It is thought that the adipofascial flap is especially effective for providing a nerve gliding surface, buffering compression, and accelerating nerve healing via an abundant blood supply. 8 Various adipofascial flaps based on the radial artery perforator and posterior interosseous artery have been used for preventing readhesion of nerves in the forearm region.…”

“…Neural adhesion of superficial radial nerve sometimes occurs when scar tissue adheres to the damaged nerve. This condition is characterized by dysesthesia and pain radiating to the nerve‐innervated area during wrist and thumb motion . Definitive diagnostic criteria for neural adhesion have not yet been established and thus diagnosis might be difficult clinically.…”

“…This condition is characterized by dysesthesia and pain radiating to the nerve-innervated area during wrist and thumb motion. [8][9][10][11] Definitive diagnostic criteria for neural adhesion have not yet been established and thus diagnosis might be difficult clinically. Some surgeons have reported that recurrent adhesion after neurolysis is not uncommon, but great care should be taken in operations for neurolysis because of the unreliable outcomes.…”