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

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.

Review of Piezoelectrical Materials Potentially Useful for Peripheral Nerve Repair

“…If the nerve gap was not protected and bridged, the surrounding connective tissue would proliferate in this period and physically block most of the elongating axons from the proximal stump from reaching the distal nerve stump. Traditionally, autologous dispensable nerves or veins are used to bridge nerve defects [65][66][67]. More recently, allogenic nerve grafts and artificial nerve-guiding conduits (NGC) were introduced, and are in widespread use [13,32].…”

“…Allogenic nerve grafts have been associated with inflammatory reactions akin to rejection responses. Generally, both allogenic nerve grafts and NGC have been associated with worse functional results than autologous nerve grafts or flaps, particularly for longer nerve defects [13,16,32,35,[65][66][67][68].…”

Utilization of the Rat’s Tail as a Novel Model for Arterialized Venous Flap

“…Current flap models like the abdominal-based AVFs rarely mimic common clinical configurations of the venous flap. [5][6][7][8] We introduce the rat's tail as a donor site for venous flap harvest and present preliminary results obtained with this pilot study.…”

Reconstruction of a 10-mm-long median nerve gap in an ischemic environment using autologous conduits with different patterns of blood supply: A comparative study in the rat

“…[ 20 ] These nerve flaps are based on the anatomical proximity of the venous system to multiple nerves, particularly in the subcutaneous tissue. [ 21 , 22 ] ANVFs are thus composed of expendable nerve segments and adjoining veins. [ 21 ] Usually, one end of the vein is anastomosed to a recipient site artery and the other end is connected to a recipient site vein.…”

“…[ 21 , 22 ] ANVFs are thus composed of expendable nerve segments and adjoining veins. [ 21 ] Usually, one end of the vein is anastomosed to a recipient site artery and the other end is connected to a recipient site vein. [ 22 ] ANVFs can be harvested easily from multiple places of the body, particularly from the limbs, having a relatively expedite dissection.…”