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• W3115135689 abstract "Moschella and Cordova originally reported the utility of the reverse dorsoradial flap for thumb soft-tissue reconstruction. To ensure success with this procedure, special attention should be paid not to visualize the dorsoradial digital artery during pedicle dissection because this carries the risk of damaging the tiny perivascular venules.1 As visualizing the vascular anatomy in the pedicle area is not advisable, what anatomical landmark can be used to locate the vascular axis and ensure including these vessels in the flap pedicle, especially when a narrow pedicle is harvested? Although designing the pedicle wide enough can reduce the probability of not harboring these vessels, an excessively bulky pedicle may result in poor aesthetic appearance.2 Alternatively, as described in previous studies, a Doppler probe could be used to identify the dorsoradial digital artery preoperatively. However, this device is generally not available in basic level hospitals, and such a small vessel is not always easily detectable. Previous well-conducted anatomical study has demonstrated that the dorsoradial digital artery runs in close approximation to the dorsal collateral branch of the superficial radial nerve.3 Understanding this anatomy is key to locating the flap pedicle in a different manner and making appropriate adjustments. In this communication, we would like to propose a simple nerve-pull technique for locating the vessels in a pedicle area. Intraoperatively, the incision is initiated along the proximal edge of the flap to dissect the sensory collateral nerve. Once the entire flap is raised, a longitudinal pull is applied gently and repeatedly in line with the nerve enclosed in the flap, and movements of the distal part can be observed. [See Video 1 (online), which demonstrates the sensory collateral nerve-pull technique to locate the vascular axis.] By doing so, the nerve embedded in the pedicle area can be easily and precisely identified; in other words, the vessels are safely “visualized,” while avoiding skeletonizing the pedicle. Then, the pedicle is harvested along this vascular axis with a cuff of the surrounding fatty tissue and the tourniquet is deflated to confirm flap circulation. [See Video 2 (online), which shows robust blood supply immediately after surgery.] {href:Single Video Player,role:media-player-id,content-type:play-in-place,position:float,orientation:portrait,label:Video 1.,caption:This video demonstrates the sensory collateral nerve-pull technique to locate the vascular axis.,object-id:[{pub-id-type:doi,id:},{pub-id-type:other,content-type:media-stream-id,id:1_4byrpeg8},{pub-id-type:other,content-type:media-source,id:Kaltura}]} {href:Single Video Player,role:media-player-id,content-type:play-in-place,position:float,orientation:portrait,label:Video 2.,caption:This video shows robust blood supply immediately after surgery.,object-id:[{pub-id-type:doi,id:},{pub-id-type:other,content-type:media-stream-id,id:1_cijotxgl},{pub-id-type:other,content-type:media-source,id:Kaltura}]} We believe that this nerve-pull technique is extremely helpful in locating the vessels within the pedicle. The most prevalent complication with this flap is venous congestion caused by excessive compression of the pedicle. In our experience, the circumference of the pedicle can be safely narrowed with the precise location of the dorsoradial digital artery, and there has been no evidence that a narrow flap pedicle (<0.9 cm) can result in venous insufficiency. From an aesthetic standpoint, unnecessary width of the flap pedicle may prevent easy primary closure without skin grafts or skin bridge,4 thus producing a less aesthetically pleasing result. In conclusion, the sensory collateral nerve pull technique can be safely and effectively used in harvesting the pedicle of the Moschella flap. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article." @default.
• W3115135689 created "2021-01-05" @default.
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• W3115135689 date "2020-12-30" @default.
• W3115135689 modified "2023-09-27" @default.
• W3115135689 title "The Sensory Collateral Nerve-Pull Technique: A Viable Maneuver to Aid Harvesting the Pedicle of the Moschella Flap" @default.
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• W3115135689 doi "https://doi.org/10.1097/prs.0000000000007663" @default.
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