Background: The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF. Methods: A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies from 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure. Results: Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively. Conclusion:The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFFF. Future studies should
Background: Targeted muscle reinnervation (TMR) is a surgical procedure for treating symptomatic neuroma, in which the neuroma is removed and the proximal nerve stump is coapted to a donor motor branch innervating a nearby muscle. This study aimed to identify optimal motor targets for TMR of the superficial radial nerve (SRN). Methods: Seven cadaveric upper limbs were dissected to describe the course of the SRN in the forearm and motor nerve supply—number, length, diameter, and entry points in muscle of motor branches—for potential recipient muscles. Results: The radial nerve provided three (three of six) motor branches, two (two of six) motor branches, or one (one of six) motor branch to the brachioradialis muscle, entering the muscle 21.7 ± 17.9 to 10.8 ± 15 mm proximal to the lateral epicondyle. One (one of seven), two (three of seven), three (two of seven), or four (one of seven) motor branches innervated the extensor carpi radialis longus muscle, with entry points 13.9 ± 16.2 to 26.3 ± 14.9 mm distal from the lateral epicondyle. In all specimens, the posterior interosseous nerve gave off one motor branch to the extensor carpi radialis brevis, which divided into two or three secondary branches. The distal anterior interosseus nerve was assessed as a potential recipient for TMR coaptation and had a freely transferable length of 56.4 ± 12.7 mm. Conclusions: When considering TMR for neuromas of the SRN in the distal third of the forearm and hand, the distal anterior interosseus nerve is a suitable donor target. For neuromas of the SRN in the proximal two-thirds of the forearm, the motor branches to the extensor carpi radialis longus, extensor carpi radialis brevis, and brachioradialis are potential donor targets.
Background The radial forearm free flap (RFFF) is widely used and is considered one of the workhorse flaps in oncologic head and neck reconstructions. However, the potential for significant donor-site morbidity remains a major drawback. Although various donor-site problems have been reported, the incidence of neuropathic pain and possible predicting factors remain unclear. This study aimed to identify the incidence, prognostic factors and impact on quality of life of neuropathic pain following RFFF harvest. Methods In this multicenter, cross-sectional study, 167 patients who underwent a RFFF reconstruction between 2010-2020 were included. Baseline characteristics were collected by medical charts. All patients received questionnaires to measure patient’s pain (Doleur Neuropathic 4 and VAS Pain), hand function (Patient Rated Wrist Hand Evaluation) and quality of life (EuroQol 5D). Multiple logistic regression was used to identify prognostic factors associated with outcomes. Results A total of 114 patients (68%) completed the questionnaire. Neuropathic pain was present in 18% of all patients. Donor-site wound problems, mostly tendon exposure, occurred in 32% and was significantly correlated with neuropathic pain (p=0.003). Neuropathic pain was significantly associated with poorer quality of life (p<0.001) and poorer hand function (p<0.001). Conclusion Almost one-fifth of all patients deal with neuropathic pain following RFFF harvest. Neuropathic pain is significantly correlated with poorer hand function and a poorer quality of life. Therefore, future research should focus on analyzing surgical factors such as the management of wound problems and primary denervation to improve hand function and quality of life of these patients.
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