Use of intercostal nerves as nerve grafts in hand reconstruction with rectus abdominis flaps

Abstract

Following complex crush and avulsion hand injuries with significant tissue loss and exposed vital structures, microvascular tissue transplantation can reliably provide soft tissue coverage in one setting. Rectus abdominis muscle free flaps are frequently used in hand reconstruction because of the ease of dissection, low donor site morbidity, reliable, large diameter vessels for anastomosis, and supine positioning of the patient, allowing two teams of surgeons to work simultaneously reducing the operative time.’ Because of the segmental innervation of the rectus muscle, it is not used for functional transplantation, and the innervating intercostal nerves are routinely sacrificed during harvesting of muscle. We propose that the intercostal nerves within the rectus sheath can be used for primary nerve grafting in complicated hand injuries when soft tissue loss requires rectus muscle free flaps for coverage and nerve grafting is attempted within the injury.