Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report

Abstract

Summary: As the transgender population increases, gender-affirming surgeries are being performed at unprecedented rates. Despite this increase, complications and long-term outcomes of gender-affirming interventions are largely understudied. We present a transgender patient who underwent radial forearm free flap (RFFF) phalloplasty as part of gender affirmation. Immediately following surgery, the patient reported paresthesia in the donor arm in the median nerve distribution followed by a neuropathic pain after 1 week. The patient complained of shooting and burning pain and reported a loss of sensation and function at the donor site. Electromyography and magnetic resonance imaging results indicated median nerve damage several inches above the donor site. The symptoms persisted for several months before spontaneously resolving. The spontaneous resolution and location of injury suggest that nerve damage occurred as a result of pneumatic tourniquet application despite adherence to all clinical guidelines for a safe tourniquet application of the same. This is the first reported case of neuropathic pain following RFFF phalloplasty occurring at the donor site. Given the large donor area and the long time of tourniquet application, surgeons offering RFFF phalloplasty must be aware of and actively counsel patients seeking this procedure about the potential for nerve-related damages before surgery.

Neuropathic pain prevalence and risk factors in head and neck cancer survivors

“…Pain in this region may also result from radiation delivered to the brachial plexus, 39 especially via intensity‐modulated radiotherapy 40 . We also found that patients reported lower back and lower extremities as sites of pain, which may be related to arthritis or alternatively, may have been sites for flap reconstruction surgery which has been associated with neuropathy 72–74 . Additional studies are needed to validate our findings.…”

“…40 We also found that patients reported lower back and lower extremities as sites of pain, which may be related to arthritis or alternatively, may have been sites for flap reconstruction surgery which has been associated with neuropathy. [72][73][74] Additional studies are needed to validate our findings. We found that use of analgesia among HNC survivors was low, especially among those with NP, but that those with NP reported higher intake of opioid analgesics.…”

Radial Nerve Palsy Due to Blood Pressure Cuff Compression after Prolonged Combined Plastic Surgery

“… 7 Nerve damage due to tourniquet application has been shown to emerge from either direct nerve compression or ischemia, particularly if it is applied for more than 3 hours. 8 Thus, alternating the arm used for monitoring blood pressure and decreasing the circle time for patients undergoing prolonged procedures might help reduce the likelihood of such occurrences. Patient positioning in theater also plays a crucial role in the development of compression injuries.…”

The first case of chronic inflammatory demyelinating polyneuropathy after transsexualism and continuous testosterone administration

“…Gender dysphoria is a mismatch between physical sex and psychological gender identity. Gender‐affirming surgeries and hormone therapies are currently increasing, but long‐term outcomes of these therapies are largely understudied 2 . Although both CIDP and gender dysphoria can severely affect the quality of life, little is known about their relationship.…”