Campodonico Andrea, Pangrazi Pier Paolo, De Francesco Francesco, Riccio Michele
Department of Reconstructive Surgery and Hand Surgery, AOU Ospedali Riuniti di Ancona, Ancona, Italy.
Arch Plast Surg. 2020 Mar;47(2):187-193. doi: 10.5999/aps.2019.00654. Epub 2020 Mar 15.
Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.
上肢神经损伤是一种常见病症，有证据表明，在延迟重建或长神经缺损重建的情况下，周围神经修复后的功能恢复可能有限。一名26岁男性因玻璃碎片导致右前臂广泛钝器伤就诊，伴有软组织缺损、桡动脉和尺动脉完全横断以及正中神经大段缺损。患者接受了清创术，随后进行手术，采用游离桡侧筋膜皮瓣显微外科手术为手部提供直接血供；皮瓣内的头静脉用作带血管化腔室包裹腓肠神经移植物，修复正中神经的大段缺损（14厘米）。术后，患者接受了强化康复计划，并在5年随访期间对其功能表现进行监测。我们的评估显示，先前受麻痹影响的肌肉出现皮肤亲和性且有足够肌力抵抗强阻力（M5），正中神经区域刺激定位良好，两点辨别觉恢复不完全（S3+）。我们提出了一种新颖有效的方法来修复与上肢创伤相关的>10厘米周围神经缺损损伤。
