Double-layered Free Temporal Fascia Flap to Prevent Readhesion after Tenolysis and Neurolysis in the Forearm : A Case Report

Abstract

A 27-year-old woman was injured on her right forearm by a conveyor belt. The distal part of her radius, ulna, a part of her skin and adipose tissue were absent, and tendons and nerves remained but were severely damaged. Four days after the injury, we performed bone reconstruction with a free vascularized fibula flap. However, adhesion of the flexor tendons and median nerve occurred despite aggressive rehabilitation. Three months after the injury, tenolysis and neurolysis were performed, and the peeled tendons and median nerve were wrapped by a double-layered free temporal fascia flap. 54 weeks after the operation, the flexor tendons had good excursion, but paresthesias remained in a part of the median nerve region.
Adhesions are a frequent complication after trauma in the distal part of the forearm. Several methods to treat this complication have been reported such as wrapping the nerves and tendons with thin and well-vascularized tissue. We report a case in which free vascularized double-layered adipofascial tissue from the temporal region was wrapped. Although the patient continued to experience paresthesias, we consider this procedure to be useful in cases in which the adhesions occur over a wide area.