À propos d’un cas exceptionnel de syndrome de Volkmann néonatal traité par transfert libre de grand dorsal ré-innervé

Abstract

Congenital Volkmann ischemic contracture is a rare entity. The neonate presents nerve palsy, cutaneous and muscular necrosis of the forearm. We report a case of a newborn who presented with necrotic subcutaneous tissue of the right forearm and absence of active flexion and extension of the wrist and fingers. She was initially treated with debridement of necrotic tissues and orthosis of the wrist. Latissimus dorsi free flap was used for forearm reconstruction at age of 7months. The thoracodorsal nerve was anastomosed with a motor branch of the median nerve. The proximal part of the muscle was fixated to the lateral epicondyle of humerus, and the distal part of muscle was sutured with a flexor digitorum tendons and radial extensor carpi. The cutaneous component of the flap was used to cover a defect of soft tissue of the forearm. At age of 12months, the patient has a good two-hand function with a pollici digital clamp of the right hand. She also has a recovery of active wrist extension and fingers flexion. Free re-innervated latissimus dorsi muscle transfer is an alternative to restore a useful hand function in case of congenital Volkmann ischemic contracture.