Neuropathic Donor-Site Pain following Radial Forearm Free Flap Harvest: A Multicenter Study on Incidence, Prognostic Factors, and Quality of Life

Abstract

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.

Fasciocutaneous and jejunal free flaps for circumferential hypopharyngeal defect reconstruction: A 22‐year multicenter cohort study

“…Possible complications and disadvantages of RFFF harvest include the inability to close the wound primarily, necessitating the use of skin grafts with a risk of tendon exposure, reduced range of motion, postoperative neuropathic pain, and numbness. 5,9,[23][24][25][26] Reported advantages of ALTFFs include possibility of primary wound closure, availability of a large skin paddle, a long vascular pedicle and the presence of robust fascia to reinforce the suture layer. 2,8 However, in obese patients, a bulky ALTFF may hinder the ability to properly tube the flap.…”

“…While FCFF donor‐site complications do not commonly necessitate surgical intervention—as was also observed in our study—it is important to take the relative donor‐site morbidity profile of each flap into account. Possible complications and disadvantages of RFFF harvest include the inability to close the wound primarily, necessitating the use of skin grafts with a risk of tendon exposure, reduced range of motion, postoperative neuropathic pain, and numbness 5,9,23–26 . Reported advantages of ALTFFs include possibility of primary wound closure, availability of a large skin paddle, a long vascular pedicle and the presence of robust fascia to reinforce the suture layer 2,8 .…”

“…Multivariable analysis identified low perioperative albumin levels (p = 0.018) and prior cerebrovascular disease (7% vs. 31%, p = 0.03), as significant risk factors for severe adverse donor-site events in the JFF group. Median serum albumin levels were comparable between groups (FCFF 28 g/L, IQR 25-32; JFF 27 g/L, IQR [23][24][25][26][27][28][29][30][31]. No other significant risk factors for fistulas, strictures, flap failures, or severe adverse donor-site events were identified.…”

Innovative Strategies in Microvascular Head and Neck Reconstruction

“…For soft tissue reconstruction, a myriad of different donor sites are available, but concerns with donor site morbidity are becoming increasingly scrutinized. The radial forearm flap, which was historically the primary option for a thin pliable donor site, has been criticized more frequently in the modern era with the popularity of alternate donor sites that can avoid a skin graft and potential cold intolerance, and impaired function of the upper extremity [ 77 , 78 , 79 ]. The search for the ideal donor site remains elusive, but likely there is no single donor site that is ideal, and the reconstructive microsurgeon must decide which donor site to use based on the extent and type of defect as well as the patient’s body habitus and available donor sites [ 80 ].…”