Free myocutaneous flap transfer to treat congenital Volkmann's contracture of the forearm.

The purpose of this study is to report our experience with free functional muscle transfer procedures for the late sequelae of the rare condition of congenital Volkmann's ischaemic contracture of the forearm. Four children, with an average age of 9.5 years (range 1.5-17), were treated and were followed for a mean of 6 years (range 1-14). Two patients had dorsal forearm contractures, and two had both flexor and extensor forearm contractures. We carried out free functional muscle transfers to replace the flexor or extensor muscles. The functional result was assessed according to the classification system of Hovius and Ultee. All patients had wrist contractures and skeletal involvement with limb length discrepancy that influenced the outcome. All five transferred muscles survived and improved the function of the hand in three of the four patients. LEVEL OF EVIDENCE 4.

Congenital Volkmann syndrome and aplasia cutis of the forearm: a challenging differential diagnosis.

IMPORTANCE: Differential diagnosis between congenital Volkmann ischemic contracture (CVIC) and unilateral aplasia cutis congenita (ACC) type VII of the forearm presents a clinical challenge. Both diseases share the same clinical presentation characterized by a stellate ulceration over the upper extremities and reported association with neuromuscular defects, but the diagnostic criteria to differentiate these 2 entities remain unclear. OBSERVATIONS: A newborn girl presented with an ulceration of the left forearm associated with an apparent neurological impairment. On the basis of the suspected neurological involvement, a diagnosis of CVIC was initially considered, but because the neurological evaluation excluded paralysis, our final diagnosis was ACC type VII. CONCLUSIONS AND RELEVANCE: In our opinion, CVIC should be considered a particular form of ACC in which an external noxa affects the forearm, increasing the intracompartmental pressure and leading to muscle and nerve ischemia. Therefore, we propose that the definition of Volkmann ischemic contracture should be maintained only for the acquired forms with an evident etiology and that Frieden's classification scheme for ACC type VII needs to be reformulated.

[Free re-innervated Latissimus Dorsi musculocutaneous flap for treat congenital Volkmann ischemic Contracture: a case report]. / À propos d'un cas exceptionnel de syndrome de Volkmann néonatal traité par transfert libre de grand dorsal ré-innervé

OBJECTIVES: Congenital Volkmann ischemic contracture is a rare entity. The neonate presents nerve palsy, cutaneous and muscular necrosis of the forearm. METHODS: We report a case of a newborn who presented with necrotic subcutaneous tissue of the right forearm and absence of active flexion and extension of the wrist and fingers. She was initially treated with debridement of necrotic tissues and orthosis of the wrist. Latissimus dorsi free flap was used for forearm reconstruction at age of 7months. The thoracodorsal nerve was anastomosed with a motor branch of the median nerve. The proximal part of the muscle was fixated to the lateral epicondyle of humerus, and the distal part of muscle was sutured with a flexor digitorum tendons and radial extensor carpi. The cutaneous component of the flap was used to cover a defect of soft tissue of the forearm. RESULTS: At age of 12 months, the patient has a good two-hand function with a pollici digital clamp of the right hand. She also has a recovery of active wrist extension and fingers flexion. DISCUSSION: Free re-innervated latissimus dorsi muscle transfer is an alternative to restore a useful hand function in case of congenital Volkmann ischemic contracture.

Congenital Volkmann ischemic contracture: a case report.

Congenital Volkmann ischemic contracture is a rare condition in which a neonate presents with an ulcerated forearm, necrotic subcutaneous tissue, nerve palsy, and muscular necrosis. We report a case of a 1-day-old infant who presented with an ulceration of the left forearm noted at delivery combined with decreased motor function of the left distal forearm. Histologic examination of the ulceration revealed findings of subcutaneous fat necrosis of the newborn. To our knowledge, this is the first case for which the findings of subcutaneous fat necrosis have been seen histologically.