Recovery of sensitivity to cold, warmth and pain caused by excessive heat in various types of free microvascular flaps was studied psychophysically in 27 patients who had undergone such operations four months to four years earlier. A thermal stimulator based on the Peltier principle and controlled by a microprocessor was used to measure the sensitivity to temperature in the transplants. The results were compared with the measured thresholds in the opposite sites in corresponding normal body areas. The present study showed that sensitivity to cold, warmth, and pain caused by excessive heat did return to some free microvascular flaps. According to the measurements the sensation started to return after 6 months in some flaps, and all types of thermal stimuli were felt by one patient as early as 10 months after operation. The return was more pronounced in younger people and in smaller flaps. If the hands, feet, or head defects were reconstructed with a thin skin flap (posterior aspect of thigh, dorsum of foot, or subscapular) the recovery of sensitivity was verified. Sensation returned to the musculocutaneous and osteomusculocutaneous transfers if they were on the hands or the head, or if they were sutured to healthy tissue with normal sensation. The main advantage of the psychophysical sensory testing method that we used is that it gave exact numerical data that made it possible to compare results among the different patient groups and even those obtained at different clinics and laboratories.

A clinical study of touch, pain, warm and cold stimuli and two-point discrimination was performed in 27 free flaps four months to four years after the microsurgical procedure. There were 5 free skin flaps (2 with nerve suture), 15 musculocutaneous, 4 muscle-covered with split skin grafts and 3 osteomusculocutaneous flaps transplanted to various sites on the body. The results show full or nearly full recovery of touch and pain sensation in all free skin flaps. The musculocutaneous and osteomusculocutaneous free flaps developed good sensation if firmly grown onto the healthy recipient skin with normal sensation. Muscle flaps covered with split skin grafts and all flaps surrounded by scar tissue had a clinical absence of sensation. This study and our earlier findings of the regeneration of nerves in free skin grafts, in skin flaps and in experimental free flaps, lead us to suggest that the healthy denervated skin of the free flap provides a strong neurotrophic stimulus to the cut cutaneous nerves in the edges of the recipient skin. Cutaneous nerves freely regenerate in the loose subcutaneous tissue of the flap. We therefore conclude that all free flaps with skin islands have a potential for developing sufficient protective touch and pain sensation and even some superficial sensitivity.

In a material consisting of approximately 6,000 injections of Adriamycin during a 2-year period, eleven moderate and five severe extravasation injuries have been observed. Even a small leakage of the drug may cause a permanent lesion. The most serious injuries were caused by large doses and on the dorsum of the hand. Plastic surgical operations were successfully performed in the severe cases. An active surgical intervention after primary neutralization of the extravasated Adriamycin is recommended.

The long-term results of 44 patients who underwent breast reconstruction after mastectomy with latissimus dorsi musculocutaneous flaps with endoprostheses were studied. Good symmetry without a brassiere was achieved in 15 patients, slight asymmetry in 24 and poor symmetry in five (11%). Symmetry when a brassiere was worn was acceptable in all but one of the patients (43/44). A third of the patients (n = 13) had developed unacceptable (grade III or IV) capsular contraction, but 39 (89%) of the patients studied were satisfied with the long-term reconstruction. Cutaneous sensibility, measured by von Frey's test, had returned to 28 (64%) of the cutaneous skin islands, to their medial parts in particular. The flaps in patients who had received concentrated radiation or who had large prostheses remained numb. Sensation was normal in the scars of the donor areas in all but three patients. Latissimus dorsi breast reconstruction with an endoprosthesis is safe and simple. It gives a subjectively satisfactory result in nine out of 10 patients and is therefore a valuable method of reconstruction after mastectomy.

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