Reconstruction of entrapped median nerve

Following prior sarcoma resection with skin grafting of the left forearm, the patient shown had intolerable pain and limited finger flexion (A). In the operating room, the skin graft and surrounding skin were resected and the flexor tendons were adherent to the surrounding scar tissue (B). The ablated median nerve stump was also entrapped in the scar. After freeing the tendon (tenolysis) and nerve (neurolysis) from the scar, the nerve was reconstructed using an autograft harvested from the sural nerve. The soft tissue was covered with the free lateral upper arm flap (C).