Enrico Martin

219 Nerve reconstructions in extremity STS Ulnar nerve One study reported the reconstruction of 10 centimeter ulnar nerve defect with the use of sural nerve grafts after resection of a sarcoma at the level of the elbow. 39 Restoration of finger and wrist flexion and sensation in the distribution of the ulnar nerve were adequate (M3 and S3 respectively) 12 months postoperatively. The elbow extension deficit was reconstructed with an innervated latissimus dorsi flap. This patient also received adjuvant radiotherapy. Digital nerve(s) Five studies reported on seven patients having undergone reconstruction of one or more digital nerve(s). 38,40–43 Most reconstructions (6/7) were performed using a nerve graft, either the LABCN or sural nerve grafts. All but one digital nerve did not recover good sensation (protective or S3-S4). 40,41,43 MSTS scores were good to excellent (80-100%) in three patients, 38,42 while one patient did not obtain good function postoperatively (MSTS 53%, DASH 43). 42 Concomitant tendon defects were reconstructed using transfers or silicon rods. 38,42,43 One study reported a VAS pain outcome score which was 0 in both patients. 42 The use of adjuvant therapy did not result in failed reconstructions in at least three out of four patients. 40,42,43 Sciatic nerve Three studies reported a total of seven patients with reconstructions of the sciatic nerve ( Table 2 ). 44–46 All reconstructions were performed using nerve grafts, using the sural nerve, the (superficial) peroneal nerve or a combination of both. Preoperative sensory and motor deficits differed between patients, most likely depending on location of defect. Recovery of motor function was functional in only one patient, 46 while two others regained M1 dorsiflexion. 44,45 No recovery of motor function was seen in any of the other patients. 44 Sensation ameliorated in 6 out of 7 patients, all of which gave at least slight protection in some part of the foot. The other patient had a positive Tinel’s sign 18 centimeters distally from the reconstruction site at 12 months. Slight protective and protective sensation of the foot sole was gained in three patients only. 44,45 All patients had some form of multimodal treatment. Peroneal nerve One patient was reported to have a reconstruction of the deep peroneal nerve at the level of the ankle. 47 A composite gracilis flap was used and the anterior obturator nerve was used to reconstruct the peroneal nerve defect. The gracilis muscle was used for reconstruction of ankle and toe motion. Both motor and sensory recovery were good at seven months postoperatively. 9