Greater defects of the palm after tumor resections need coverage with a vascular-pedicled or free flap. Restoration of sensibility is a major aim in reconstruction of the palm. End-to-side neurorrhaphy of the nerve of the flap to the common digital nerves of the palm offer an excellent possibility of sensory reinnervation without harm to the sensory supply of the surrounding palm or the fingers.

One 17-year-old patient with an epitheloid cell sarcoma and one 62-year-old patient with a squamous cell carcinoma of the palm had to be treated by deep resection onto the functional structures of the palm. Coverage was obtained with a distally-pedicled radial forearm flap in both cases. An end-to-side neurorrhaphy of the distal N. cut. antebrachii lat. to the common digital nerve III/IV was performed in the first patient. Dellon´s PSSD-device was used to document resensibilisation of the flap.

Both patients developed sensitivity all over the flap area within the first year after operation. The patient with end-to-side neurorrhaphy achieved PSSD values between 6 and 15 g/mm˛ with a homogenous distribution over the whole flap so far, normal values being 2 g/mm˛ in the index finger. 2-PD is possible (7mm) within the flap. In comparison the similar flap in the patient without nerve suture PSSD values were between 28 and 42 g/mm˛, and 2-PD was not recovered. Sensibility of area supplied by the donor nerve remained normal after end-to-side nerve suture and flap sensibility was localized by the patient into the palm. Neither motor nor sensory function of the hand was limited by the procedure.

End-to-side neurorrhaphy is an excellent method for resensibilisation of flaps isolated from their original sensory nerve supply and with no donor nerve for end-to-end nerve suture in the recipient area.