[A microsurgical patient, a procedural dilemma].

We are presenting a case which had five operations with the central point being the microsurgery. The patient is admitted in our unit 48 ours after sustaining a complex trauma of the left forearm with cvasicomplete destruction of the volar muscles, defects on cubital and radial vasculo-nervous axes and the median nerve. Upon arrival we performed the staged surgical debridement, ligature of the radial and ulnar vessels, anchoring of the ends of the nerves, forearm volar and dorsal fasciotomies, followed by skin grafting. After five months, the grafted skin is replaced by an ipsilateral parascapular free flap. After other three months we repaired the nerves by the mean of sural nerve grafts. The particularity of the case consists in fact that the ulnar nerve, with a longer defect, was reconstructed in a two stage approach. Long-time follow up (one year) shows a very good functional clinical result, confirmed by electromyography. Apart from the clinical challenge, this case confronted us with tactical dilemma. In a case of the facial nerve for the best results the cross-face is performed in two stages. Why shouldn't we do the same thing for all the nerve grafts when we are faced to semnificative defects?