Physical Address
304 North Cardinal St.
Dorchester Center, MA 02124
Forearm Reconstruction
Clinical Presentation
A 24-year-old Black American female sustained an avulsion injury to her left forearm wound secondary to a motor vehicle accident. She sustained a large complex soft tissue wound, measuring 18 × 8 cm, in the left volar forearm with multiple flexor digitorum superficialis muscle injuries and a transection of the median nerve with a 5-cm gap. The radial artery and its accompanied veins within the wound were also transected ( Figs. 18.1 and 18.2 ). The plastic surgery service was consulted to provide a soft tissue reconstruction for her forearm as well as the medial nerve reconstruction once she was cleared by the trauma service.
Operative Plan and Special Considerations
Based on the location and size of the soft tissue defect in the forearm as well as the nature of the reconstruction to provide a good skin coverage to the forearm, a free anterolateral thigh (ALT) perforator flap was offered to this patient for the reconstruction of such a large forearm wound. The ulnar artery system was also evaluated for its patency and adequacy to ensure an adequate blood supply to the hand. In addition, perforators in each thigh’s potential donor site were mapped by duplex scan so that a preferred site for free ALT perforator flap harvest could be chosen. The sural nerve from the left leg was prepared as a nerve graft donor site for the cable nerve grafting of the medial nerve gap.
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