Division of Plastic Surgery, Oregon Health & Science University, Portland, Oregon, USA; School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
School of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
J Plast Reconstr Aesthet Surg. 2022 Oct;75(10):3836-3844. doi: 10.1016/j.bjps.2022.06.075. Epub 2022 Jun 24.
In the radial forearm phalloplasty multiple nerves are harvested to provide phallic sensation, resulting in iatrogenic nerve injuries. Despite this, nerve morbidity following this procedure has been minimally assessed. The purpose of this study was to assess donor site nerve morbidity following radial forearm phalloplasty.
Patients who underwent gender-affirming phalloplasty at our institution between 2016-2020 using the radial forearm were included. Pain characteristics were assessed with a modified Mackinnon Pain questionnaire consisting of 33 items, including visual analog scales (VAS) for reporting of pain and impact on aspects of quality of life (QoL), as well as 20 descriptive pain adjectives and a 21-item questionnaire to capture overall pain experience.
A total of 37 patients were included. 31 had minimal-mild pain (VAS scores 0-3), and 6 patients had moderate-severe pain (VAS scores 4-10). The mild pain group reported a mean 2.74 (0-7) pain descriptors and reported minimal impact on QoL metrics. The moderate-severe pain group reported mean 6.33 (2-15) pain descriptors and reported significant impacts on QoL metrics. Significant differences were observed with decreased QoL (p = 0.018), increased sadness (p = 0.009), increased frustration (p = 0.030), increased anger (p = 0.0496), and decreased hopefulness (p = 0.0496) in the moderate-severe pain group along with interference of pain with sleep (p = 0.002).
In a cross-sectional analysis of 37 patients who underwent gender-affirming radial forearm phalloplasty, the majority (31) experienced a minimal degree of donor site nerve pain. Six patients suffered from more significant nerve pain that was associated with a decreased QoL. Treatment and prevention of this nerve pain represent important areas for future exploration.
在游离前臂阴茎成形术中，为了提供阴茎感觉，会采集多条神经，从而导致医源性神经损伤。尽管如此，该手术的神经发病率评估却很少。本研究旨在评估游离前臂阴茎成形术后供区神经的发病率。
纳入 2016 年至 2020 年间在我院接受性别肯定性阴茎成形术且使用游离前臂的患者。使用改良的 Mackinnon 疼痛问卷评估疼痛特征，该问卷包含 33 个项目，包括疼痛报告的视觉模拟量表（VAS）和对生活质量（QoL）的影响，以及 20 个描述性疼痛形容词和 21 个问题来捕捉整体疼痛体验。
共纳入 37 例患者。31 例患者疼痛程度为轻度至中度（VAS 评分为 0-3），6 例患者疼痛程度为中度至重度（VAS 评分为 4-10）。轻度疼痛组报告的平均疼痛描述符为 2.74（0-7），对 QoL 指标的影响最小。中重度疼痛组报告的平均疼痛描述符为 6.33（2-15），对 QoL 指标的影响显著。中重度疼痛组的 QoL 显著降低（p=0.018）、悲伤感增加（p=0.009）、挫败感增加（p=0.030）、愤怒感增加（p=0.0496）和希望感降低（p=0.0496），疼痛对睡眠的干扰也显著增加（p=0.002）。
在对 37 例接受性别肯定性游离前臂阴茎成形术的患者进行的横断面分析中，大多数（31 例）患者的供区神经疼痛程度较轻。6 例患者出现更严重的神经痛，与 QoL 降低有关。这种神经痛的治疗和预防是未来需要探索的重要领域。
