Chimerization of Monitor Flap in a Vascularized Ulnar Nerve Flap Is an Efficient Way for Vascularity Monitoring and the Reinnervation Checkup after Its Transplantation.

Abstract

Background  Free vascularized ulnar nerve flaps (VUNF) are effective method for long nerve defects reconstruction. However, the monitorization of its microvascular circulation and the nerve regrowth can be challenging since it is usually designed as a buried flap. We designed a skin paddle based on a septocutaneous perforator from the ulnar artery that can be dissected and raised in conjunction with the vascularized ulnar nerve flap, which aims to improve postoperative monitorization to optimizing the clinical results. Methods  We retrospectively reviewed 10 cases with long nerve defects who underwent reconstruction using VUNF between June 2018 and June 2019, including eight acute brachial plexus injuries, 1 multiple nerve injury due to a rolling machine accident, and 1 sequalae of nerve injury after arm replantation. All the demographic data, surgical details, outcomes, and perioperative complications were recorded. Results  We evaluated 10 male patients, with a mean age of 34 ± 16 years. Cases included 5 antegrade, 4 retrograde, and 1 U-shaped VUNF. All chimeric skin paddles survived, and all of the underlying nerves presented with adequate circulation and functional improvement. There were no intraoperative or microvascular complications. One skin paddle had a transitory postoperative circulation compromise due to external compression (bandage) which resolved spontaneously after pressure release. Conclusion  VUNF chimerization of a septocutaneous perforator skin flap is a relatively easy and efficient method for postoperative monitorization of the nerve's microvascular circulation as well as beneficial for postoperative Tinel's sign checkup to confirm the success of the nerve coaptation. The outcome is potentially improved.