Clinical and histological results of sensory recovery after radial forearm flap transfer

Abstract

The necessity of nerve anastomosis in an attempt to regain dermal sensitivity following pedicled or free-flap transfer has been the basis of many discussions. In our study, we investigated the degree of sensory recovery with emphasis on the different nerval qualities, on the radial forearm flap and correlated it to the histological and immunohistological findings. Nineteen patients with radial forearm free flap -five of whom underwent nerve anastomosis -were examined. The follow-up interval was 20.3 months (average) after surgical intervention. Histological examinations were performed on 13 of the 19 patients, in eight cases on one occasion and in five on more than one occasion. Seventeen patients experienced sensory recovery, whereby the degree and quality of dermal innervation varied. In comparison, the nerval reconstruction did not lead to any significant improvement. Based on our clinical results, we regard the nerve reconstruction during the radial forearm free flap transfer as unnecessary. To what extent this can be said for other flaps demands further investigation.

Comparison of spontaneous sensory recovery of noninnervated anteromedial thigh flap, latissimus dorsi flap, and gracilis muscle flap in lower extremity reconstruction: A prospective comparative study

“…Most of the previous studies that compared spontaneous sensory recovery and recovery after nerve coaptation yielded controversial results. Certain studies showed a benefit in sensory recovery after nerve coaptation, whereas others reported satisfactory spontaneous reinnervation from the surrounding skin (Ayhan Oral, Zeynep Sevim, Gorgu, & Yucel Oztan, ; Schultes, Gaggl, & Karcher, ; Vesper, Heiland, Blake, Flinzberg, & Schmelzle, ; Vesper, Heiland, Flinzberg, & Schmelzle, ). Furthermore, a comparison of the existing literature is difficult as different examination modalities and times were employed (Beugels et al, ).…”

Standardized Quantitative Sensory Testing to assess insufficient recovery of touch discrimination in free flap surgery in extremity reconstruction

“…10 In contrast, in oral cavity reconstruction using radial forearm flaps and latissimus dorsi flaps, sensory reinnervation has been shown in neurotized and nonneurotized flaps [19][20][21] with some authors reporting no superior improvement in flaps with nerval reconstruction. 19,20 Moreover, satisfactory partial sensory reinnervation has also been described in nonneurotized free flaps in breast reconstruction. [6][7][8][9]11,12,15,[22][23][24][25][26] In addition, studies investigating sensory recovery after free flap surgery are difficult to compare as modalities and interpretation of sensory outcomes are unstandardized and vary widely.…”

“…7–9,11–16 Similarly, in extremity reconstruction, previous studies describe overall diminished sensory recovery gradually improving over time 2,10,17,18 and faster recovery in neurotized flaps. 10 In contrast, in oral cavity reconstruction using radial forearm flaps and latissimus dorsi flaps, sensory reinnervation has been shown in neurotized and nonneurotized flaps 19–21 with some authors reporting no superior improvement in flaps with nerval reconstruction. 19,20 Moreover, satisfactory partial sensory reinnervation has also been described in nonneurotized free flaps in breast reconstruction.…”

“…10 In contrast, in oral cavity reconstruction using radial forearm flaps and latissimus dorsi flaps, sensory reinnervation has been shown in neurotized and nonneurotized flaps 19–21 with some authors reporting no superior improvement in flaps with nerval reconstruction. 19,20 Moreover, satisfactory partial sensory reinnervation has also been described in nonneurotized free flaps in breast reconstruction. 6–9,11,12,15,22–26…”

Lower Lip Reconstruction Using a Functioning Gracilis Muscle Free Flap

“…It is important to point out that when performing a free gracilis for lip reconstruction, we always consider whether it is feasible to add the Pribaz facial artery musculomucosal (FAMM) flap 31 and sensory innervation to restore sensation at the reconstructed lip. 32,33 A FAMM flap at the resection step of the procedure can be prepared; it provides inner mucosa coverage of the new lip and the vermilion. The FAMM flap, according to Pribaz, can be inferiorly or superiorly based.…”