The outcomes and prognosis after a traumatic nerve lesion remain uncertain and heavily dependent on the local environment, which can predispose perineural fibrosis. Studies have shown that interposing adipose flaps can create a well-vascularized barrier against scar tissue, thereby promoting peripheral nerve regeneration. We report the use of freestyle adipose flaps for wrapping peripheral nerves after a trauma, regardless of the nerve injury location.

We retrospectively reviewed patients who underwent a nerve wrapping with a local freestyle adipose flap. Data collected included age, nerve involved, cause and location of irritation, flap vascularization, follow-up duration, pain, patient satisfaction, and complications.

We included 6 patients, aged 11 to 60 years, with a minimum follow-up of 12 months (range: 12–24 months). Cases involved contusion of 2 radial nerves after humerus fractures, 1 ulnar nerve elongation at the elbow after arthrolysis and 1 median nerve neuroma-in-continuity in the forearm, 1 femoral cutaneous nerve neuroma-in-continuity, 1 sural nerve neuroma-in-continuity at the ankle after lacerations. All patients experienced pain, 4 had dysesthesia, and the 2 patients with radial nerve involvement also had motor paralysis. A local freestyle adipose flap was used for each patient, with excellent clinical perfusion noted intraoperatively. No complications were observed. All patients reported significant pain relief and were satisfied at the last follow-up.

In animal studies, vascularized adipose flaps have been shown to accelerate revascularization, enhance nerve regeneration and decrease fibroblast infiltration, by providing adipose stem cells and an optimal nutritional environment. Multiple adipose flaps have been described in human for compression neuropathies with good results (i.e.: the vascularized hypothenar fat pad transposition after a carpal tunnel release). There are 3 small cases series on post-traumatic nerve lesion wrapping with pedicle adipose flaps but those are only applicable in specific locations. Yamamot et al. even described the use of a free temporoparietal flap for resurfacing a radial nerve neuroma with good results. The main advantage of using freestyle adipose flaps is that they are available regardless of injury location, as limbs have numerous available perforators. This non-comparative retrospective study highlights the feasibility of those freestyle adipose flaps both in upper and lower limbs. This technique is straightforward with minimal risk of complications.

Freestyle adipose flaps provide a flexible and well-vascularized envelope that promotes nerve recovery and cushioning. Our report underscores the effectiveness of a simple surgical technique that is applicable regardless of the nerve lesion location.