Anatomic study and clinical application of neuromyocutaneous flap based on nutritional vessel of median nerve palmar cutaneous branch

Abstract

Objective To investigate the anatomical features of neuromyocutaneous flap based on nutritional vessel of median nerve palmar cutaneous branch and evaluate the clinical application of this flap for repairing soft tissue defect of the thumb. Methods Thirty adult cadaver hand specimens were dissected after red Latex perfusion. The configuration, branches, and distributions of the nutritional vessel of median nerve palmar cutaneous branch and its anastomoses with thenar musole vessels were observed. Since February 2007, neuromyocutaneous flap distally based on the nutritional vessel of median nerve palmar cutaneous branch was transferred to repair soft tissue defect of 17 thumbs. Results Superficial palmar branch of the radial artery gives out 3-5 myocutaneous perforators to abductor pollicis brevis and flexor pollicis brevis. Those perforators form the nutrient vessel chain of palmar cutaneous branch of the median nerve. The external diameter of the perforators was (0.3±0.1 )mm on average. It is accompanied by one. vein. All of the 17 cases of neuromyocutaneous flap survived. The function and appearance of the thumbs were good. One week after the surgery, the average two-point discrimination at thumb pulp resurfaced by the flaps was (6.1-8.2) ram in 11 cases. Conclusion There exists anastomosis between the nutritional vessel chain of median nerve palmar cutaneous branch and the perforators of abductor pollicis brevis and flexor pollicis brevis. The neuromyocutaneous flap is a good option to repair soft tissue defect of the thumb. Key words: Surgical flaps; Median nerve; Thumb; Anatomy,regional