Formation of a sensate forearm stump through neurovascular tissue transplantation

Abstract

The use of neurovascular flaps can help to maximize limb length and gain sensory re-innervation in amputees. We describe the case of a 19-year-old patient who underwent an innovative reconstructive approach aimed at preserving viable limb length with sensory regeneration by using innervated tissue transfer after traumatic upper extremity amputation below the elbow. The forearm length was maximized by means of two neurovascular free flaps that formed a robust, functional, and versatile stump. The mechanism of this reconstruction originated from the practice of placing a double-innervated anterolateral thigh flap over a myocutaneous flap for covering protruding forearm bone shafts. This form of vascularized tissue transplantation helps to minimize the risk of necrosis of radial and ulnar bone shafts. In this patient, an upper arm prosthesis would have been necessary if lower arm bone shafts had been shortened for primary wound closure. Therefore, the newly formed stump enabled the patient to wear a forearm prosthetic instead of a less functional upper arm device. In addition, neurovascular tissue transfer facilitates sensory re-innervation, improvement of the healing process and serving a protective function over the covered area. Through co-adaptation of free nerve endings, neuroma formation can also be prevented. To ensure long-term success, it is vital that the patient be in good mental and physical health, as well as demonstrate the capacity for long-term rehabilitation therapy prior to performing such reconstructions.

Level of Evidence: Level V, therapeutic study.

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