Treatment of a patient suffering from posttraumatic painful neuromas formed at the bilateral digital nerves of the left middle finger using two neurovascular.

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Treatment of a patient suffering from posttraumatic painful neuromas formed at the bilateral digital nerves of the left middle finger using two neurovascular island flaps Shunki Iemura, Ryosuke Kakinoki, Kazuhiro Ohtani, Kazuhiko Hashimoto, Fumihisa Nakamura, Hiroki Tanaka, Masao Akagi JPRAS Open Volume 19, Pages 1-5 (March 2019) DOI: 10.1016/j.jpra.2018.10.001 Copyright © 2018 The Authors Terms and Conditions

Figure 1 Schematic diagram of the operation. A: donor site of the flap. B: neurovascular island flap, C: radial palmar digital artery, D: radial palmar digital nerve, E: dorsal branch of the radial palmar digital nerve, F: radial dorsal digital nerve, G: a stump of the ulnar palmar digital nerve, H: a stump of the radial palmar digital nerve, I: distal stump of the dorsal branch of the radial palmar digital nerve (coagulated). J: proximal stump of the dorsal branch of the radial palmar digital nerve, K: proximal stump of the dorsal digital nerve (coagulated), L: proximal stump of the radial palmar digital artery (ligated). JPRAS Open 2019 19, 1-5DOI: (10.1016/j.jpra.2018.10.001) Copyright © 2018 The Authors Terms and Conditions

Figure 2 Left: Exploration of the amputated finger tip. The amputated stumps of the bilateral palmar digital nerves were identified. a: stump of the ulnar palmar digital nerve, b: stump of the radial palmar digital nerve. Middle: the radial palmar digital artery and the surrounding fat tissue were separated from the radial palmar digital artery. c: the radial palmar digital artery. Right: Skin defects at the flap donor site and over the vascular pedicle of the flap were covered by an artificial dermis (d). e: the neurovascular flap was drastically reduced. JPRAS Open 2019 19, 1-5DOI: (10.1016/j.jpra.2018.10.001) Copyright © 2018 The Authors Terms and Conditions

Figure 3 The left middle finger tip one year after surgery. The flap survived, and pain was represent. JPRAS Open 2019 19, 1-5DOI: (10.1016/j.jpra.2018.10.001) Copyright © 2018 The Authors Terms and Conditions