Free vascularized deep peroneal neurocutaneous flap for repair of digital nerve defect involving severe finger damage

Koshima, Isao; Murashita, Toru; Soeda, Shinji

doi:10.1016/s0363-5023(10)80101-7

Cited by 16 publications

(6 citation statements)

References 9 publications

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“…A finger neurocutaneous defect poses a reconstructive challenge. The challenge lies in resurfacing the finger with a good‐quality pliable and sensate skin cover and providing good cosmetic results. For the closure of a neurocutaneous defect, various options exist.…”

Section: Discussionmentioning

confidence: 99%

A Novel Approach for Reconstruction of Finger Neurocutaneous Defect: A Sensory Reverse Dorsal Digital Artery Flap from the Neighboring Digit

Feng

Sun

Cheng

et al. 2017

Orthopaedic Surgery

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Section: Discussionmentioning

confidence: 99%

A Novel Approach for Reconstruction of Finger Neurocutaneous Defect: A Sensory Reverse Dorsal Digital Artery Flap from the Neighboring Digit

Feng

Sun

Cheng

et al. 2017

Orthopaedic Surgery

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“…Another important aspect to minimizing nerve allograft immunogenicity is to use multiple nonvascularized cables instead of one large-caliber vascularized graft. Although use of large-caliber vascularized nerve grafts has been advocated in a variety of situations, [69][70][71] use of a vascularized allograft would require inclusion of some length of highly immunogenic allograft vascular pedicle that would require lifelong immunosuppression to maintain. On the other hand, animal research shows that the volume of transplanted tissue does not alter the resultant immune response.…”

Section: Means To Minimize Immunosuppression In Nerve Allograft Recipmentioning

confidence: 99%

Experience with Nerve Allograft Transplantation

Fox

Mackinnon

2007

Seminars in Plastic Surgery

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Nerve allograft transplantation should be used for the repair of devastating peripheral nerve injuries that cannot be reconstructed through traditional means such as autologous nerve grafting or nerve transfer procedures. The risks of required systemic immunosuppression, although only temporary for nerve allograft recipients, preclude widespread use of this treatment modality. Translational research has led to several advancements in this field including the use of preoperative allograft cold preservation in University of Wisconsin organ preservation solution and inclusion of tacrolimus as part of the immunosuppressive regimen. Investigation of how to further diminish nerve allograft immunogenicity, speed neuroregeneration by use of agents such as tacrolimus, and promote preferential motor regeneration will further advance this field with the goal of restoring optimal function while minimizing patient morbidity.

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“…Vascularized deep peroneal nerve grafts with dorsalis pedis vessels 1415 or first metatarsal vessels 25 have recently been reported and, compared with defects repaired with conventional free nerve grafts, excellent nerve recovery has been demonstrated. Rose and Kowalski 14 demonstrated excellent sensory recovery in anesthetic scarred digits with the use of the deep peroneal nerve-dorsalis pedis artery complex and with reversed venous arterialized nerve grafts 15 from the dorsum of the foot.…”

Section: Discussionmentioning

confidence: 99%

Free Vascularized Deep Peroneal Nerve Grafts

Koshima¹,

Okumoto²,

Umeda³

et al. 1996

J reconstr Microsurg

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An ideal donor site for vascularized nerve grafts should have a constant anatomy, minimal functional loss after the nerve has been sacrificed, and a dependable blood supply parallel to the nerve over a relatively long distance. Creating a pedicle for a free vascularized deep peroneal nerve graft with the anterior tibial vessels seems to be a most suitable method for repairing long nerve gaps of over 20 cm and digital nerve defects with severe finger damage. Applications of this nerve graft to digital nerve losses with severely scarred beds created by avulsion injury, and two-stage reconstruction in some partial brachial plexus palsies (free vascularized nerve graft in the first stage and free vascularized muscle graft in the second stage) are well indicated. Advantages of this technique are: (1) A long nerve graft (up to 25 cm) can be obtained, and anomalies are rare (the nerve is absent in only 4 percent of cases). (2) The caliber of the vascular pedicle is large (approximately equal to 3 mm). (3) The nerve has a sufficient blood supply from the collateral blood vessels. (4) The graft can be easily obtained in the supine position. (5) A monitoring skin flap, based on the inferior lateral peroneal artery, can be attached to the nerve graft. (6) Sensory loss resulting from the sacrifice of the nerve covers a minimal area. (7) A donor scar on the anterior aspect of the lower leg is more acceptable than one on the posterior aspect because of less movement in walking. Disadvantages of this technique are: (1) Sacrifice of the large vessels in the lower leg may result in circulatory complications in the donor foot; to avoid this problem, preoperative angiography is recommended. (2) The donor scar is in an exposed area in female patients. (3) There may be temporary postoperative edema and disability in the donor leg.

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Free vascularized deep peroneal neurocutaneous flap for repair of digital nerve defect involving severe finger damage

Cited by 16 publications

References 9 publications

A Novel Approach for Reconstruction of Finger Neurocutaneous Defect: A Sensory Reverse Dorsal Digital Artery Flap from the Neighboring Digit

A Novel Approach for Reconstruction of Finger Neurocutaneous Defect: A Sensory Reverse Dorsal Digital Artery Flap from the Neighboring Digit

Experience with Nerve Allograft Transplantation

Free Vascularized Deep Peroneal Nerve Grafts

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