Patterns of sensory and autonomic reinnervation of long-standing myocutaneous microvascular flaps and split-skin grafts applied to fascial beds

Abstract

A Juma, D Oudit, M Ellabban. Patterns of sensory and autonomic reinnervation of long-standing myocutaneous microvascular flaps and split-skin grafts applied to fascial beds. Can J Plast Surg 2005;13(1):16-22.BACKGROUND: There is a paucity of reports in the literature examining the pattern of sensory and autonomic neural recovery of myocutaneous microvascular flaps and skin grafts to the lower limbs after a prolonged period of time. OBJECTIVES: To investigate the recovery of sensation and autonomic nerve activity in long-standing split-skin grafts applied to fascial beds and in myocutaneous microvascular flaps. METHODS: The patients were divided into two groups: group A consisted of patients with a split-skin graft applied to a fascial bed (n=11) and group B consisted of patients with free microvascular flaps (n=4). Patients in both groups underwent various clinical subjective and objective tests, including the measurement of electrical resistance and thermal sensory analysis. Laser Doppler flowmetry was used to investigate the blood flow patterns. RESULTS: Patients in both groups showed significantly reduced sensory modalities. However, the findings of both the electrical resistance and laser Doppler flowmetry were significantly different among the patients in group A compared with controls. In contrast, electrical resistance and laser Doppler flowmetry test results were similar in group B and controls. CONCLUSIONS: Both split-skin grafts applied to fascial beds and microvascular flaps on the lower limb had poor sensory recovery. However, after 15 years, the microvascular flaps regained the ability to sweat and some degree of thermoregulatory function. This may imply that the long-standing myocutaneous free flaps regained some aspects of their autonomic innervation, whereas the split-skin grafts had not.

The fate of sensation in non-innervated perforator free flaps in the lower extremity

“…Skin grafts are known to follow random recovery pattern, supporting the idea that nerve ending from the bed will regenerate in a multidirectional manner to the graft. 33,34 However, in this study, most defects extended beyond the normal cutaneous nerve structures. Thus, peripheral sensory recovery will most likely occur from the surrounding cutaneous nerves regenerating from the periphery of the flap and ultimately toward the center of the flap, which was also similarly observed by Dellon (Fig.…”

The Adrenergic System in Plastic and Reconstructive Surgery

“…Although studies examining peripheral nerve sensory recovery postfree flaps are numerous, evaluations of autonomic reinnervation are scarce 107 . Surgical autonomic repair can be used to restore functional capacity, as evidenced by end to side autonomic reanimation to treat erectile dysfunction postprostatectomy 108,109 .…”

“…Although studies examining peripheral nerve sensory recovery postfree flaps are numerous, evaluations of autonomic reinnervation are scarce. 107 Surgical autonomic repair can be used to restore functional capacity, as evidenced by end to side autonomic reanimation to treat erectile dysfunction postprostatectomy. 108,109 Additionally, the sympathetic chain may be repaired after sympathectomy for primary hyperhidrosis in patients suffering from compensatory hyperhidrosis after this procedure.…”