Anatomical study and clinical relevance of the flexor superficialis synovial flap: an assessment of 31 hand dissections.

PURPOSE: The authors present an anatomical study of the flexor digitorum superficialis synovial flap and its clinical application for palmar soft tissue defects in hand trauma. METHODS: Green latex was injected into the brachial artery of thirty-one human upper limbs from corpses donated to science. Anatomical features of this pedicled flap were assessed: arterial vascularization, dimensions and covering surface. RESULTS: The anatomical support of this flap is the synovial tissue of the flexor tendons, and particularly the superficial layer of the synovial system, covering the flexor digitorum superficialis (FDS) tendons in the forearm. It is vascularized by four different arteries: a constant collateral branch of the ulnar artery, and three inconstant arterial supports: from collateral branches of the superficial palmar arch, from the radial artery, and from the vasa nervorum of the median nerve. The flap is harvested from proximal to distal on the ulnar pedicle to cover the palmar soft tissue defects of the hand. A clinical application of this synovial flap is presented via a case report for covering a palmar skin defect secondary to a hand injury. CONCLUSIONS: The synovial flap contains a constant ulnar pedicle and could be considered a useful alternative to cover palmar soft tissue defects.

End-to-side neurorrhaphy for median nerve repair after elbow tumor resection: case report.

We report a case of a median to ulnar end-to-side neurorrhaphy with epineurectomy but without fascicular donor nerve section. Surgery was performed for the curative treatment of an elbow synovial sarcoma at the level of the elbow that necessitated resection of 10 cm of the median nerve. The patient was followed up for 24 months. After 4 months, a recovery of protective sensation in the territory of the median nerve was noticed and had stabilized by 1 year.