Reconstruction of complex tissue defect of forearm with a chimeric flap composed of a sural neurocutaneous flap and a vascularized fibular graft: A case report

Abstract

One-stage reconstruction of composite bone and soft-tissue defects in the forearm remains a tough challenge. Here, we present a case of reconstruction of complex tissue defect at forearm with a chimeric flap consisting of a sural neurocutaneous flap and a fibular graft. A 61-year-old man suffered from a machine crush injury in his left forearm, resulting in a complex tissue defect including extensive dorsomedial soft-tissue, digit extensor muscles of 2-4 fingers, the muscle flexor carpi ulnaris, the ulna bone with 5.5 cm in length, segmental injuries of ulna nerve and vessels, and the radius fracture. The defects were reconstructed by a modified chimeric flap, in which the sural neurocutaneous flap supplied by a peroneal perforator was used to repair the soft-tissue defect and the vascularized fibular graft was used to repair the ulna defect. The two components were supplied by the peroneal vessels. The ulnar nerve defect was bridged by a sural nerve graft. The venous congestion caused by thrombosis was observed at 24 hours postoperatively. After the venous anastomosis was reperformed, the flap survived completely without other complications. Bone healing was achieved at the 7-month follow-up. The index and middle fingers reached nearly full range of motion, while the ranges of motion of metacarpophalangeal joint of the ring and little fingers were less than 60 degrees. The results showed that the modified chimeric flap may be an option for reconstruction of complex tissue defect in the forearm.

Severe spaghetti wrist injury: Should we expand the terminology from wrist to proximal forearm?

“…[ 23 ] However, laceration of the proximal forearm muscle belly in our study was all sutured to cover the repaired vessels and nerves in case of desiccation and for potential necrosis, if the injury damaged the ambiguous blood supply of the muscle belly. [ 24 ] To the best of our knowledge, this is also the first report to compare the outcomes of lacerated wrist and proximal forearm,[ 25 ] in which incredible similarity in the aspects of demographic characteristics, such as age, sex ratio, and mechanism and side of injury, and outcomes of tendon function, intrinsic muscle function and sensory, were observed despite the fact that patients in the two groups were lacerated at different levels of the forearm. One of the possible reasons is that simultaneous artery and nerve injury often occurs within deep wounds, which indicates multiple tendon/muscle ruptures with limb- or even life-threatening severity.…”

Upper Limb Salvage Surgery Due to Explosion Using Vacuum-Assisted Closure: A Case Report

“…At Wang C and Hayashida K used a perforator-based sural neurocutaneous flap for the reconstruction of complex forearm injuries. However, due to the lack of availability of microsurgery and when raising a flap needs to be well vascularised to avoid pedicle torsion or compression (1,5), this technique could not be performed in a country with low healthy infrastructure, like Somalia. So, we preferred vacuum-assisted closure because it is a simple and effective method of treating traumatic soft tissue defects instead of doing free flap transplantation, which is unavailable due to the inaccessibility of microsurgery.…”

“…Hight trauma injuries of the forearm frequently present with complex bone and soft tissue defects. Early repair is required to retrieve the extremity and restore its function (1). With the advance of surgical repair and reconstruction technology, limbs damaged by high-energy trauma that might have needed to be amputated in the past can now be saved by surgical reconstruction; severe upper limb crush injuries differ from lower limbs, as upper limbs have fewer muscles, longer ischemic tolerance times, and complex functions that artificial limbs cannot replace compared to lower limbs.…”

Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making

“…Fibula autograft was the only structural autograft used in included literature [19,21,22,23,24,25,26,27,28,29,30,32,49]. Eleven publications comprising 65 patients (73%) reported on the use of vascularized fibula autograft [21,22,23,24,25,26,27,28,30,31,49]. All cases employed the use of a single vascularized fibula graft and no double barrel or Capanna type grafts were used.…”