CASE: A 71-year-old male presents with neuropathic pain in his left superficial radial nerve (SRN) distribution under his radial forearm free flap donor site. This was used to reconstruct an open lower-limb fracture 11 years ago. Electrophysiology revealed SRN denervation and MRI showed thickening and scarring suggestive of an SRN neuroma 12cm proximal to the radial styloid. This site clinically correlated with junction of a volar split-thickness skin graft and normal dorsal skin. While waitlisted for exploration, he sustained a mid-forearm chainsaw injury, lacerating extensor pollicis brevis tendon and SRN, however the nerve was not repaired, leading to increased pain. METHOD: After discussing management options preoperatively, surgical exploration demonstrated an SRN injury over 8cm length with both acute and chronic damage. Given the extent of damage, we performed neurectomy and targeted muscle reinnervation (TMR) coapting the proximal SRN to a redundant flexor carpi radialis (FCR) branch of median nerve. This provided a distal nerve target, preventing symptomatic neuroma and treating neuropathic pain. The patient’s preference was to avoid sural nerve autologous grafting. RESULTS: Short-term follow-up demonstrated a significant improvement in neuropathic pain, however, as expected, paraesthesia persisted. The patient is scheduled for ongoing follow-up to assess progress. CONCLUSION: There are several learning points from this case. It underscores the importance of recognizing long term complications in radial forearm donor sites, highlights the consequences of undetected neural injuries over time which lead to symptomatic neuroma formation, and it introduces an alternative technique for managing neuromas through TMR.