"Sensory Switching" in Elbow Reconstruction.

Kazunobu Hashikawa,Hiroto Terashi,Shunsuke Sakakibara

doi:10.1055/s-0035-1549369

Kazunobu Hashikawa, Hiroto Terashi + Show 1 more

Open Access

https://doi.org/10.1055/s-0035-1549369

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Abstract

In the treatment of the soft tissue defect of the elbow, flap reconstruction is necessitated in many cases because of thinness of soft tissue at this region. In addition, reacquirement of tactile sensation is desirable because of the anatomical and specific functions of the elbow. Of three cases treated for elbow defects, one was reconstructed with a pedicled island forearm flap containing the lateral cutaneous nerve of the forearm, another was reconstructed with a venoneuro-accompanying artery fasciocutaneous flap (VNAF flap) containing the basilic vein, and the third with the VNAF flap containing the cephalic vein. The three cases demonstrated a sudden change of sensory territory 4 to 6 months after surgery, which was confirmed by touching the reconstructed region with patients' eye-closed: from its original territory to the elbow in a "switching"-like action. Here we describe and discuss the concept of "sensory switching."

Highlights

There are some functionally important elements for hand and arm movements in the elbow such as muscles, tendons, and nerves; damage to soft tissue of the elbow may cause crucial disruption of hand and arm functions
We describe three cases of elbow injury reconstructed with pedicle flaps containing the sensory nerves, and discuss the concept of “sensory switching.”
Sensory reacquirement relies on the invasion of sensory nerves surrounding the graft; tactile sensation is hardly restored

Summary

Introduction

There are some functionally important elements for hand and arm movements in the elbow such as muscles, tendons, and nerves; damage to soft tissue of the elbow may cause crucial disruption of hand and arm functions. Some options are available for the reconstruction of general soft tissue defects, a specific strategy for elbow reconstruction is needed in addition to the reacquirement of tactile sensation because of its anatomy and specific functions, as this region is a weight-bearing site and necessitated to avoid injury such as pressure sore. With the use of a pedicle flap, because reconstruction of the sensory nerve at the defect is usually not possible by suturing, the sensory territory of the flap at the donor site can be often conserved. We describe the new concept of “sensory switching” that may be related to the plasticity of the sensory cortex. We describe three cases of elbow injury reconstructed with pedicle flaps containing the sensory nerves, and discuss the concept of “sensory switching.”

Case Presentation

Discussion