Adipofascial Perforator Flaps for Peripheral Nerve Resurfacing after External Neurolysis

Area of Science:

• Plastic Surgery
• Orthopedic Surgery
• Neurosurgery

Background:

• Peripheral nerve entrapment often requires external neurolysis, but limited soft tissue for closure can lead to epineural scarring and surgical failure.
• Recurrent or extensive neurolysis presents a challenge due to paucity of overlying soft tissue for nerve coverage.
• Vascularized tissue reconstruction using adipofascial perforator flaps is explored for challenging nerve entrapment cases.

Purpose of the Study:

• To evaluate the intermediate-term outcomes of using adipofascial perforator flaps for vascularized tissue resurfacing of nerves.
• To assess the safety and efficacy of this technique in patients with limited soft tissue after external neurolysis.

Main Methods:

• Retrospective review of patients undergoing external neurolysis and subsequent soft tissue reconstruction with local adipofascial flaps.
• Data collected included patient demographics, symptom duration, surgical details, flap type, follow-up duration, pain scores, and sensory testing.
• All flaps were based on named perforating vessels from adjacent axial vessels.

Main Results:

• Six patients (four female, ages 39-60) with 17-25 months follow-up were included.
• All patients experienced substantial pain relief (≥5-point reduction on VAS) and objective sensory improvement.
• One minor complication (superficial wound dehiscence) occurred; average operative time for flap was 74 minutes.

Conclusions:

• Adipofascial perforator flaps are a safe and effective method for vascularized soft tissue reconstruction in challenging peripheral nerve entrapment cases.
• The technique is applicable to both upper and lower extremities, demonstrating positive intermediate-term safety and pain outcomes.
• This approach addresses the limitations of primary closure in cases with scarce soft tissue following neurolysis.