Comparison of sensory recovery at the subfascial and suprafascial donor sites of the free radial flap

Avery, C.M.E.; Sundaram, Karthikeyan; Jasani, V.; Peden, Alex E.; Neal, Christopher P.

doi:10.1016/j.bjoms.2011.10.011

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…23,29 It has been suggested that raising an RFFF in the suprafascial plane less often leads to tendon exposure compared with the subfascial plane, as the fascia provides an extra tissue layer between tendons and graft. 27 Second, head and neck cancer patients often suffer from comorbidities and unhealthy lifestyle, including tobacco and alcohol abuse, diabetes, and peripheral vascular disease. 35 These factors, including poor nutritional status due to malignancy itself, are all associated with poor wound healing 36,37 and may contribute to skin graft failure.…”

Section: Discussionmentioning

confidence: 99%

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Neuropathic Donor-Site Pain following Radial Forearm Free Flap Harvest: A Multicenter Study on Incidence, Prognostic Factors, and Quality of Life

Bruin

Hundepool

Duraku³

et al. 2022

J Reconstr Microsurg

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Background The radial forearm free flap (RFFF) is widely used and is considered one of the workhorse flaps in oncologic head and neck reconstructions. However, the potential for significant donor-site morbidity remains a major drawback. Although various donor-site problems have been reported, the incidence of neuropathic pain and possible predicting factors remain unclear. This study aimed to identify the incidence, prognostic factors and impact on quality of life of neuropathic pain following RFFF harvest. Methods In this multicenter, cross-sectional study, 167 patients who underwent a RFFF reconstruction between 2010-2020 were included. Baseline characteristics were collected by medical charts. All patients received questionnaires to measure patient’s pain (Doleur Neuropathic 4 and VAS Pain), hand function (Patient Rated Wrist Hand Evaluation) and quality of life (EuroQol 5D). Multiple logistic regression was used to identify prognostic factors associated with outcomes. Results A total of 114 patients (68%) completed the questionnaire. Neuropathic pain was present in 18% of all patients. Donor-site wound problems, mostly tendon exposure, occurred in 32% and was significantly correlated with neuropathic pain (p=0.003). Neuropathic pain was significantly associated with poorer quality of life (p<0.001) and poorer hand function (p<0.001). Conclusion Almost one-fifth of all patients deal with neuropathic pain following RFFF harvest. Neuropathic pain is significantly correlated with poorer hand function and a poorer quality of life. Therefore, future research should focus on analyzing surgical factors such as the management of wound problems and primary denervation to improve hand function and quality of life of these patients.

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Section: Discussionmentioning

confidence: 99%

“…3 As proven in this study, wound healing has a significant influence on the occurrence of neuropathic pain. Wound management should be optimized, potentially by performing suprafascial harvest, 27 careful closure of the donor-site and early consultation of a wound care specialist, to reduce neuropathic pain prevalence.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Neuropathic Donor-Site Pain following Radial Forearm Free Flap Harvest: A Multicenter Study on Incidence, Prognostic Factors, and Quality of Life

Bruin

Hundepool

Duraku³

et al. 2022

J Reconstr Microsurg

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“…In our study we see that in the first 10 years radial flaps were primarily being used, then SCIP flaps, and in the last 10 years mostly ALT. Almost 80% of the articles included were published in the last decade, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] indicating that this a very contemporary subject in reconstructive surgery (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

Ríos

Falguera-Uceda

Ferrer

et al. 2021

Craniomaxillofacial Trauma & Reconstruction Open

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Study Design: Suprafascial free flaps have become common place in reconstructive surgery units. Nomenclature related to these flaps has not been uniform throughout the scientific literature, especially in regard to planes of dissection. This study is designed as a comprehensive review of the literature. Objectives: Our study highlights which flaps are used most frequently, their main indications, their survival rate, and how they have evolved in the last few decades as innovations have been introduced. Methods: A review of the literature was performed using keywords and Medical Subject Headings search terms. PubMed, Embase, and Cochrane Library were searched using the appropriate search terms. Data collected from each study included flap type, dissection plane, preoperative planning, area of reconstruction, as well as complications, donor-site morbidity and survival rate. Results: Seven hundred and fifty-five studies were found based on the search criteria. After full-text screening for inclusion and exclusion criteria 34 studies were included. A total of 1332 patients were comprised in these studies. The most common types of flaps used were superficial circumflex iliac perforator flap (SCIP), anterolateral thigh flap (ALT), and radial forearm flap. The most common areas of reconstruction were head & neck and limbs. There was no significant difference in survival rates between flaps that were raised in different planes of dissection. Conclusions: Based on the author’s review of the literature, suprafascial flaps are reliable, they have low donor site morbidity, and there is a wide selection available for harvest. The use of new technologies for preoperative planning, such as CT-Angiography and UHF ultrasound, have contributed to have more predictable results. We propose a standardized classification for these flaps, in order to create a uniform nomenclature for future reference.

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“…Light touch sensation in the thenar palm area was lower in the subfascial group, indicating injury to the thenar cutaneous sensory branches during dissection. 15…”

Section: Loss Of Sharp or Light Touchmentioning

confidence: 99%

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

Bruin

Hundepool

Duraku

et al. 2022

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Background: The radial forearm free flap (RFFF) has been used extensively for complex tissue defect reconstructions; however, the potential for significant donor-site morbidity remains a major drawback. Despite an abundance of literature on donor-site morbidities, no consensus has been reached on exact incidences of sensory morbidities that vary largely between 0% and 46%. Incidences of neuropathic pain in the donor site following RFFF still lack, even though clinical experience shows it often occurs. Therefore, the purpose of this systematic review was to identify the incidence of neuropathic pain and altered sensation in the hand following harvesting of a RFFF. Methods: A systematic search was performed in multiple databases (Embase, Medline, Cochrane, Web of Science, and Google Scholar). Studies from 1990 onwards that reported donor-site morbidities following harvest of the RFFF were included. Analyzed parameters included hand pain, hypoesthesia, cold intolerance, hyperesthesia, neuroma formation, paresthesia, sharp sensation loss, light sensation loss, and defect closure. Results: Of the 987 selected studies, 51 eligible articles were selected. The mean level of evidence was 3 (SD 0.6). Twenty articles reported pain as a donor-site morbidity, and the mean incidence of pain reported was 23% (SD 7.8). Hypoesthesia was reported by 37 articles and had a mean incidence of 34% (SD 25). Locations of pain and hypoesthesia included, amongst others, the area of the radial sensory nerve and the skin graft area. The mean incidences of cold intolerance and hyperesthesia were 13% (SD 13) and 16% (SD 15), respectively. Conclusion:The results of this systematic review suggest that 23% of all patients are dealing with neuropathic pain in the donor-site following harvest of an RFFF. Future studies should

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Comparison of sensory recovery at the subfascial and suprafascial donor sites of the free radial flap

Cited by 8 publications

References 18 publications

Neuropathic Donor-Site Pain following Radial Forearm Free Flap Harvest: A Multicenter Study on Incidence, Prognostic Factors, and Quality of Life

Neuropathic Donor-Site Pain following Radial Forearm Free Flap Harvest: A Multicenter Study on Incidence, Prognostic Factors, and Quality of Life

Suprafascial Free Flaps: Classification and Comprehensive Review of the Literature

Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review

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