Perforator-Based Radial Fat Flap in the Management of Nerve Injuries around the Wrist

Nerve injuries around the wrist are probably the most prevalent in traumatic peripheral nerve surgery. An appropriate suture technique under the microscope or high magnification operating loupes are mandatory to obtain a good result. However, scar adherence to the skin and surrounding structures is not infrequently responsible for postoperative pain that can delay rehabilitation and satisfactory recovery. Since 2000, the author has been using a perforator-based radial fat flap in the context of median nerve transections and painful neuromata of the radial nerve at the wrist level, to provide a cushioning isolating structure between nerve repair and skin/flexor tendons. The technique is easy to learn and expeditious to perform, offering an excellent refinement without significant additional morbidity or scar sequela.