Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
Department of Occupational Therapy, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
J Plast Reconstr Aesthet Surg. 2024 May;92:216-224. doi: 10.1016/j.bjps.2024.02.071. Epub 2024 Mar 4.
Skin-grafted free gracilis muscle flaps are commonly used for lower extremity reconstruction. However, the loss of sensory function may lead to increased patient morbidity. This study prospectively analyzed the sensory and neuropathic pain outcomes of neurotized skin-grafted free gracilis muscle flaps used for the reconstruction of lower extremity defects.
Patients undergoing lower extremity reconstructions between 2020 and 2022 with neurotized skin-grafted free gracilis muscle flaps were prospectively enrolled. Sensation was assessed at 3, 6 and 12 months postoperatively using monofilaments, two-point discrimination, a vibration device, and cold and warm metal rods. Sensations were tested in the center and periphery of the flaps, as well as in the surrounding skin. The contralateral side served as the control. Patients completed the McGill pain questionnaire to evaluate patient-reported neuropathic pain.
Ten patients were included. At 12 months postoperatively, monofilament values improved by 44.5% compared to that of the control site, two-point discrimination, cold detection, warmth detection, and vibration detection improved by 36.2%, 48%, 50%, and 88.2%, respectively, at the reconstructed site compared to those at the control site. All sensory tests were significantly better than 3 and 6 months values (p < 0.05), but remained significantly poorer than the control site (p < 0.05). Sensation in the central flap areas were similar to peripheral flap areas throughout the follow-up period (p > 0.05). The surrounding skin reached values similar to the control site at 12 months (p > 0.05). Moreover, 50% of patients reported neuropathic pain at 3 months postoperatively, 40% at 6 months, and 0% at 12 months (p < 0.05).
Mechanical detection, vibration detection, temperature detection, and two-point discrimination significantly improved over time but without reaching normal sensory function at 12 months postoperatively. Neuropathic pain resolved at 12 months.
带蒂游离股薄肌皮瓣常用于下肢重建。然而，感觉功能的丧失可能会导致患者发病率增加。本研究前瞻性分析了用于下肢缺损重建的带蒂游离股薄肌皮瓣的神经化皮瓣的感觉和神经病理性疼痛结果。
前瞻性纳入 2020 年至 2022 年期间接受带蒂游离股薄肌皮瓣神经化下肢重建的患者。术后 3、6 和 12 个月使用单丝、两点辨别、振动装置以及冷、热金属棒评估感觉。在皮瓣中心和周围以及周围皮肤测试感觉。对侧作为对照。患者完成麦吉尔疼痛问卷以评估患者报告的神经病理性疼痛。
纳入 10 例患者。术后 12 个月，与对照部位相比，单丝值提高了 44.5%，两点辨别、冷觉、温觉和振动觉在重建部位分别提高了 36.2%、48%、50%和 88.2%，与对照部位相比，所有感觉测试均显著优于 3 个月和 6 个月（p<0.05），但仍显著差于对照部位（p<0.05）。中央皮瓣区的感觉在整个随访期间与周围皮瓣区相似（p>0.05）。周围皮肤在 12 个月时达到与对照部位相似的水平（p>0.05）。此外，50%的患者在术后 3 个月报告有神经病理性疼痛，40%的患者在术后 6 个月报告有神经病理性疼痛，0%的患者在术后 12 个月报告有神经病理性疼痛（p<0.05）。
机械检测、振动检测、温度检测和两点辨别在时间上显著改善，但术后 12 个月未达到正常感觉功能。神经病理性疼痛在 12 个月时缓解。
