Less than Satisfactory Experiences with Neurovascular Island Flaps

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Abstract
While it would be wrong to draw formal conclusions from these two cases, they do at least draw attention to the fact that the transfer will be much more hazardous if the normal vascular anatomy of the hand has been altered by injury and indicate that brachial arteriography may help in such difficult problems. D. A. C. REID, Sheffield Douglas Reid showed slides of a case in which a simultaneous neurovascular island flap and a flexor tendon transfer to the thumb were undertaken using the same donor finger. The combination of injuries in this case was unique. The patient's right hand had been injured by a circular saw three months previously. The index finger was stiff and functionally useless but possessed normal sensation. The thumb had good thenar muscle function but the flexor pollicis longus had been divided and all volar sensation was absent. The volar skin of the index finger was transferred on both neurovascular pedicles to the thumb and the flexor digitorum profundus, which was found to be intact though adherent, was used to restore flexor action in the thumb. The index finger was then amputated through the metacarpal neck. Excellent function resulted. Douglas Reid has found it helpful when undertaking neurovascular island flap transfers not to exsanguinate the hand completely before applying the tourniquet to the arm. This leaves a little blood in the hand which facilitates isolation of the neurovascular bundle. Moreover, he has frequently demonstrated the venae comites accompanying the digital arteries in the hand using this technique.

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