Neurocutaneous island flaps in upper limb coverage: Experience with 44 clinical cases

Abstract

The vascularity of the cutaneous nerve of the upper limb is closely connected with the vascularity of the skin. Both skin and nerves are vascularized by perforators of the main arteries. Small longitudinal paraneural vessels, in close contact with the cutaneous nerves that they supply, link these perforating arteries. Based on these anatomic findings, 44 cutaneous flaps (so-called neurocutaneous flaps, supplied by the vessels around and inside the cutaneous nerves) were raised. The neurocutaneous flap provided reliable coverage of skin defects in the upper limb. The flap dimensions were as large as 4 x 10 cm. The proximally based flaps were extremely safe, as were the free flaps and the flaps based distally on the dorsal side of the hand. One flap distally based on the medial antebrachial cutaneous nerve of the forearm and three used in thumb reconstruction underwent necrosis. Neurocutaneous island flaps are easy to dissect, they are reliable and versatile, and major vessels like the radial, ulnar, and posterior interosseous arteries are preserved. In the majority of cases, the donor site may be closed primarily and donor site morbidity is minimal.