Vascularisation des nerfs sensitifs superficiels de l’avant-bras, applications cliniques en reconstruction de la main et des doigts

Abstract

A vascularized nerve graft is recommended when the recipient bed has poor vascularization, nerve defect is > 1 cm, or for a thick nerve. Sensory innervation also improves tissue healing, multi-tissular injuries of hand and fingers traumatisms can though benefit from flaps containing a vascularized sensitive nerve. The objective of this study was to specify the vascularization of the superficial sensitive nerves of the forearm to develop donor sites of vascularized nerves in finger and hand reconstruction. We studied the vascularization of the lateral, medial, posterior antebrachial nerves (LAbN, MAbN, PAbN) and the superficial branch of the radial nerve (SBRN) in 12 fresh cadavers injected limbs. Deep vascularization origin, location and size of the nutrient perforators, neurocutaneous vascularization data were collected. We also measured the calibre of the collateral digital pedicles for comparison. LAbN's vascularization is provided by the radial artery (92%) by 2 to 4 direct perforators > 0.5 mm diameter, located in the proximal or median third of the forearm. LAbN measures 1.33 to 1.83 mm diameter and the perforators length was 14 to 28 mm. MAbN's vascularization comes from the ulnar (67%) or brachial (25%) artery issuing 2 to 3 musculo-cutaneous perforators through the flexor carpi ulnaris muscle in the proximal third of the forearm or direct perforators in the median third. MAbN measures 1.11 to 1.21 mm diameter and the perforators were 13 to 24 mm long. These perforators vascularize the skin in more than 90% and a superficial vein in 50% of the cases for LAbN and MAbN. SBRN's vascularization comes from the radial artery. There are 1 to 2 direct perforators > 0.5 mm and 12 to 16 mm long. The skin is vascularized by the perforators in 82% of the cases and a vein in 44%. PAbN's vascularization comes from the posterior interosseous artery by musculo-cutaneous perforators The dominant nerve of every finger measures more than 2 mm diameter except for D5. The dominant artery measures 1.5 to 2 mm. This work aims to precise knowledge of the forearm cutaneous nerves vascularization for finger and hand reconstruction purposes. LAbN and MAbN are potential donor sites according to their size, vascularization type, constant location of the nutrient perforators and low donor site morbidity.