Abstract

BACKGROUND: With major advances in microsurgical techniques, free tissue transfer has become a widely adopted approach to treat complex soft tissue defects. However, sensory recovery is poor leaving the anaesthetic skin prone to injuries.METHODS: 28 patients with 22 anterior lateral thigh flaps and 6 latissimus dorsi flaps on their extremities participated in the study. Quantitative sensory testing and 2 points discrimination was performed in three test areas and one control on the contralateral unaffected extremity. Physical disability, mental health, quality of life and characteristics of pain were assessed by the painDetect, DASH, LEFS and sf12 questionnaires, respectively.RESULTS: Somatosensory profiles of all flaps were characterized by an overall loss of nerve function. Small-fibre function was mostly recovered while large-fibre function and thus touch discrimination was severely impaired. Mechanical detection thresholds improved over time and from periphery to the centre. Reported pain was mild to moderate and correlated with decreased physical function.CONCLUSION: Standardized Quantitative sensory testing provides a useful tool kit to assess the sensory regeneration after surgical treatment of soft tissue defects. After free tissue transfer small-fibre function recovers with nerve ingrowth in a centripetal direction from the flap margins to the centre, likely via collateral axonal sprouting from the undamaged nerves surrounding the flap. Myelinated fibres recover slowly and inefficiently.

View details for DOI 10.1097/PRS.0000000000009860

View details for PubMedID 36374559