Tiam Mana Saffari

38 CHAPTER 2 Figure 2. Schematic drawing of the superficial inferior epigastric fascia (SIEF) flap harvest. De - picted is the elevation of the flap from distal to proximal (A), providing a 4 x 3 cm adipofascial flap (B) with lateral branch of the superficial inferior (SIE) vessels. The SIEF flap was tunneled subcuta- neously toward the nerve without vascular twisting of the epigastric trunk (C) and wrapped around the nerve graft reaching both anastomoses (D). The flap edges were trimmed if needed and two 10-0 nylon sutures were placed to secure the position of the SIEF flap (E). With permission of the Mayo Foundation, Copyright Mayo Foundation 2019. All rights reserved. Clinical applications In 1870, Phillipeaux and Vulpian performed the first successful nerve autograft 27,42 in cases in which direct tensionless nerve repair could not be achieved. In the years after, the increased application of cable grafting instead of trunk grafts, improved clinical outcomes 24,42,43 . To further overcome the problem of ischemia in conventional nerve grafts and optimize nutrient delivery, St. Clair Strange introduced the first pedicled VNG in 1945 by using a pedicled ulnar nerve graft for the reconstruction of the median nerve 44 . It was not until 1976, when the use of a free VNG was described; a 24 cm superficial radial nerve graft based on the radial artery to reconstruct a median nerve in a 26-year-old woman 45 . Postoperative angiography at six weeks confirmed successful transfer of the radial artery and positive Tinel’s sign progressed to the distal border of the flexor retinaculum at six months, which indicated that at least a