The Effectiveness of Nerve Reconstruction Procedure with Flap Coverage for Iatrogenic Nerve Injury around the Wrist Joint

Abstract

Although treatments of trauma and degenerative disease around the wrist joint are improving, and minimally invasive techniques are attracting attention, nerve injuries occurring during surgery can be detrimental. Injury of the superficial (dorsal) branch of radial or ulnar nerve, which occurs after distal radius fracture fixation, CMCJ arthroplasty, or TFCC repair, is common.
Severe pain and abnormal sensation caused by such effects become refractory and resistant to conservative treatment, thus leading to ADL disturbance.
Refractory pain that is resistant to conservative treatment is an important indicator for surgical intervention. In such cases, nerve reconstruction with or without flap coverage depending on the nerve condition, such as a sign of allodynia or scar formation, is performed. Nine patients with these symptoms underwent surgery. The severity of the symptom had a negative impact on the clinical results. Although early intervention with only mild scarring resulted in satisfactory outcomes, severe chronic cases were often incurable. Flap coverage may be an effective procedure in terms of protecting the repaired nerve and preventing further scarring. Based on my experience, I recommend this treatment strategy considering the clinical symptoms and pathology.