title: Sensate lateral arm flap for defects of the lower leg.
abstract: Ideally, reconstruction of lower extremity soft tissue defects includes not only an esthetically pleasing 3-dimensional shape and solid anchoring to the underlying structures to resist shear forces, but should also address the restoration of sensation. Therefore, we present a prospective study on defect reconstruction of the lower leg and ankle to evaluate the role of sensate free fasciocutaneous lateral arm flap and the impact of sensory nerve reconstruction. Thirty patients were allocated randomly to the study group (n = 15) that obtained end-to-side sensate coaptation using the lower lateral cutaneous brachial nerve to the tibial nerve using the epineural window technique, or to the control group reconstructed without nerve coaptation. At 1-year follow-up the patients were evaluated for pain sensation, thermal sensibility, static and moving 2-point discrimination, and Semmes-Weinstein monofilament tests. Data from both groups were compared and statistically analyzed with the Mann-Whitney U test and the Fisher exact test. Flaps of the study group reached a static and moving 2-point discrimination and Semmes-Weinstein monofilament tests nearly equal to the contralateral leg area and significantly better than flaps of the control group. Donor damage morbidity of the tibial nerve did not occur. To our point of view resensation should be carried out by end-to-side neurorrhaphy to the tibial nerve because of the superior restoration of sensibility.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland. daniel.kalbermatten@bluewin.ch
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kalbermatten
authors.forename: Reto
authors.initials: R
authors.lastname: Wettstein
authors.forename: Oliver
authors.initials: O
authors.lastname: vonKanel
authors.forename: Paolo
authors.initials: P
authors.lastname: Erba
authors.forename: Gerhard
authors.initials: G
authors.lastname: Pierer
authors.forename: Mikael
authors.initials: M
authors.lastname: Wiberg
authors.forename: Martin
authors.initials: M
authors.lastname: Haug
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D000842:Ankle / Q000601:surgery; D001132:Arm / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000294:innervation*; D016896:Treatment Outcome