The protective value of a neurovascular island pedicle transfer in hands partially anesthetic due to ulnar denervation in leprosy.
Neurovascular skin island transfers were performed with the prime objective of protecting vulnerable anesthetic areas on the hands of patients with leprosy. After an average follow-up of eight years on sixteen patients, all had long-lasting protective benefits without further loss of tissue consequent to injury. At follow-up, two-point discrimination was less than ten millimeters in only one patient, more than twenty millimeters in ten, and indeterminate in five. Sensory misreference persisted in fourteen patients. Axon sprouting was evident in six but only over short distances (four to eight millimeters beyond the island). Compared with the intact side of the donor finger, nine of the sixteen transfers had lost some sensitivity but sensation was rated normal in one, nearly normal in six, and protective only in nine. The loss of sensation in the donor finger was less than expected and was not a problem. Scar contracture occurred in two donor and five recipient fingers, but this could be attributed to placement of the incision too far anteriorly, and hence was an unavoidable complication. Restoration of protective sensation to the ulnar border of the hand, whatever the cause of anesthesia, is considered extremely worth while.
D000293:Adolescent; D000328:Adult; D005069:Evaluation Studies as Topic; D005385:Fingers / Q000601:surgery*; D006225:Hand / Q000294:innervation*; D006230:Hand Injuries / Q000517:prevention & control; D006801:Humans; D006987:Hypesthesia / Q000601:surgery*; D007918:Leprosy / Q000150:complications* / Q000503:physiopathology; D008875:Middle Aged; D012677:Sensation / Q000502:physiology; D012867:Skin / Q000098:blood supply / Q000294:innervation; D016038:Skin Transplantation; D014182:Transplantation, Autologous; D014459:Ulnar Nerve / Q000293:injuries*