Pedicled adipofascial flaps for treatment and prophylaxis of neurodesis and neuromas in continuity of the upper extremity: A case series of 22 patients.

Introduction and objectives: Trauma to a peripheral nerve can lead to neuromas in continuity and perineural adhesions or fibrosis (neurodesis), causing pain and functional impairment. We present a retrospective study regarding our experience in managing these types of injuries using pedicled adipofascial flaps. Material and methods: We present a series of twenty-two patients treated between 2012 and 2023 for neurodesis or neuromas in continuity in the upper limb, performing external neurolysis and twenty-three adipofascial flaps. The affected nerves were the median nerve (n = 22) and the superficial branch of the radial nerve (n = 1). The ulnar artery perforator adipofascial flap was used in ten cases, the hypothenar fat pad flap in ten cases and the radial artery perforator adipofascial flap in three cases. Pain outcomes were measured using the Visual Analog Scale (VAS) pre and postoperatively, and a statistical analysis of the data was performed. STROBE guidelines were followed. Results: The average pain VAS scores pre and postoperatively were 7.13 and 2.3, respectively, representing a statistically significant improvement (p < 0.001). No statistically significant differences were found based on the type of flap used (p = 0.38) or the patients' age (p = 0.47). Complications included one surgical wound dehiscence of the donor site of an ulnar flap and another one in the recipient site (n = 2). Conclusion: Adipofascial flaps are a useful therapeutic option for managing neuromas in continuity and neurodesis of peripheral nerves in the upper extremity, achieving a significant reduction in pain.