Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Plastic and Reconstructive Surgery, UMCU, University Medical Center Utrecht, Utrecht, the Netherlands.
J Plast Reconstr Aesthet Surg. 2020 Dec;73(12):2171-2177. doi: 10.1016/j.bjps.2020.05.080. Epub 2020 May 27.
Persistent neuropathic pain severely impacts physical functioning and quality of life (QoL). However, optimal surgical management of persistent neuropathic pain remains unclear. Extensive neurolysis with subsequent free muscle flap coverage, a new surgical procedure for neuropathic pain in the upper extremity, can be performed as a final option to establish pain reduction.
All consecutive patients who received extensive microsurgical neurolysis with subsequent free muscle flap for persistent neuropathic pain in the upper extremity between 2007 and 2014 were identified. Patient-reported upper extremity function and QoL were assessed using three questionnaires (36-item short-form health survey (SF-36), the disabilities of the arm, shoulder, and head questionnaire, and the Michigan hand outcomes questionnaire).
Fifteen patients were identified; 80% had neuropathic pain in the upper extremity due to nerve injury and a median of 3.0 previous surgeries (range 1-6). Sixty-seven percent developed some kind of complication, flap loss occurred in 22%, and all received a new free flap (one failed again). At last follow-up, pre- and postoperative visual analog scale (VAS) scores significantly differed (p = 0.002), and the median VAS at last follow-up was 1.5. Ten patients (67%) responded to the questionnaires after a median follow-up of 5.7 year (range 2.6-7.3 years). Patients on average reported poorer SF-36 "Physical Component Score" (PCS) and "Bodily Pain" compared to Dutch norms. Forty percent of patients reported still having always (very) severe pain. However, 64% had a postoperative decrease of at least 3.0 on VAS.
Extensive neurolysis with free muscle flap coverage for persistent neuropathic pain in the upper extremity showed a positive effect on pain reduction on short-term follow-up, and also at five-year follow-up. The impact of pain on functional outcomes remained. Nevertheless, 60% of the patients still experience sufficient pain reduction.
持续性神经病理性疼痛严重影响身体机能和生活质量（QoL）。然而，持续性神经病理性疼痛的最佳手术治疗方法仍不明确。广泛的神经松解术，随后进行游离肌肉瓣覆盖，是治疗上肢神经病理性疼痛的一种新的手术方法，可以作为减轻疼痛的最终选择。
确定了 2007 年至 2014 年间接受广泛显微外科神经松解术和随后的游离肌肉瓣治疗上肢持续性神经病理性疼痛的所有连续患者。使用三个问卷（36 项简短健康调查（SF-36）、手臂、肩部和头部残疾问卷以及密歇根手部结果问卷）评估患者报告的上肢功能和生活质量。
确定了 15 名患者；80%的患者上肢神经病理性疼痛是由于神经损伤引起的，中位数为 3.0 次手术（范围 1-6 次）。67%的患者发生了某种类型的并发症，22%的患者出现了皮瓣坏死，所有患者都接受了新的游离皮瓣（其中一个再次失败）。末次随访时，术前和术后视觉模拟评分（VAS）有显著差异（p=0.002），末次随访时 VAS 的中位数为 1.5。在中位随访 5.7 年后（范围 2.6-7.3 年），10 名患者（67%）对问卷做出了回应。与荷兰常模相比，患者平均报告的 SF-36“生理成分评分”（PCS）和“躯体疼痛”较低。40%的患者报告始终（非常）严重疼痛。然而，64%的患者 VAS 评分至少降低了 3.0。
上肢持续性神经病理性疼痛的广泛神经松解术和游离肌肉瓣覆盖术在短期随访和 5 年随访时均显示出减轻疼痛的积极效果。疼痛对功能结果仍有影响。然而，60%的患者仍经历了足够的疼痛缓解。
