Restoration of Sensation and Thumb Opposition Using Nerve Transfers Following Resection of a Synovial Sarcoma of the Median Nerve Hollie A. Power, MD,

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Restoration of Sensation and Thumb Opposition Using Nerve Transfers Following Resection of a Synovial Sarcoma of the Median Nerve Hollie A. Power, MD, Ida K. Fox, MD, Lorna C. Kahn, BScPT, Susan E. Mackinnon, MD Journal of Hand Surgery Global Online Volume 1, Issue 3, Pages 185-189 (July 2019) DOI: 10.1016/j.jhsg.2019.05.004 Copyright © 2019 The Authors Terms and Conditions

Figure 1 Right volar forearm defect immediately after resection. Journal of Hand Surgery Global Online 2019 1, 185-189DOI: (10.1016/j.jhsg.2019.05.004) Copyright © 2019 The Authors Terms and Conditions

Figure 2 Reconstruction of right median nerve with motor and sensory nerve transfers. a Donors and recipients in palm. Black arrow, fourth common digital nerve (ulnar); black asterisk, nerve to ADM; yellow arrow, distal median nerve with white vessel loops around the first and second common digital nerves; yellow asterisk, recurrent motor branch. b Nerve transfers completed. Blue arrow, end-to-side transfer of the distal fourth common digital nerve to the digital nerve to the ulnar side of the little finger. c Proximal stump of median nerve in forearm with 5-cm ANA dwindling graft. The hemostat created a crush injury to move the regenerative front proximally. Combined with the ANA, it was used to prevent neuroma formation. The distal end of the ANA was transposed proximally deep to the flexor muscles. Journal of Hand Surgery Global Online 2019 1, 185-189DOI: (10.1016/j.jhsg.2019.05.004) Copyright © 2019 The Authors Terms and Conditions

Figure 3 Soft tissue coverage of right forearm with left free gracilis muscle flap. a Defect after nerve transfer surgery. b Left gracilis muscle flap in situ. Black asterisk, medial femoral circumflex vessels; white vessel loop, obturator nerve to gracilis (not coapted during flap inset). c Anastomosis of ulnar artery and venae comitantes to medial circumflex femoral vessels (yellow asterisk). d Final flap inset with split-thickness skin graft coverage. Journal of Hand Surgery Global Online 2019 1, 185-189DOI: (10.1016/j.jhsg.2019.05.004) Copyright © 2019 The Authors Terms and Conditions

Figure 4 Appearance 4 months after surgery. Journal of Hand Surgery Global Online 2019 1, 185-189DOI: (10.1016/j.jhsg.2019.05.004) Copyright © 2019 The Authors Terms and Conditions

Figure 5 Semmes-Weinstein monofilament sensory testing of the right hand. a At 3 months after surgery. b At 15 months after surgery. Numbers in the legend represent monofilament sizes. Journal of Hand Surgery Global Online 2019 1, 185-189DOI: (10.1016/j.jhsg.2019.05.004) Copyright © 2019 The Authors Terms and Conditions