The Journal of Bone and Joint Surgery, Vol 60, Issue 3 328-334, Copyright © 1978 by Journal of Bone and Joint Surgery, Inc
The protective value of a neurovascular island pedicle transfer in hands partially anesthetic due to ulnar denervation in leprosy
DA Ranney and WM Lennox
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.
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