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DOI: 10.5999/aps.2019.00584
Sensory assessment of meshed skin grafts over free gracilis muscle flaps without nerve coaptation for lower extremity reconstruction
This study was supported by the Sino-Swiss Science and Technology Cooperation (Project No.: EG 07-032014), and the Swiss Society of Plastic, Reconstructive and Aesthetic Surgery.![](https://www.thieme-connect.de/media/10.1055-s-00051611/202102/lookinside/thumbnails/10_5999_aps_2019_00584_224-1.jpg)
Background Little is known about the sensate recovery of skin grafts over free non-neurotized muscle flaps. The aim of this study was to evaluate the sensitivity of free gracilis muscle flaps and meshed skin grafts without nerve coaptation.
Methods Thirteen consecutive patients with a median age of 55 years (range, 21–70 years) who underwent lower extremity reconstruction between September 2014 and October 2016 were included. Complications, flap contour, skin perception, and sensate recovery were assessed.
Results All flaps survived completely. In one patient, wound dehiscence and infection occurred 1 month after surgery. After a median follow-up of 14 months (range, 10–51 months), a satisfactory contour and skin perception were achieved. The Semmes-Weinstein (SW) monofilament test (154.8±22 g) and static two-point discrimination (2-PD) (12.6±0.7 mm) showed intermediate recovery compared to the surrounding site (41% and 76%, respectively). There was an intermediate correlation between flap size and sensate recovery (2-PD: r=0.27, P=0.36; SW test: r=0.45, P=0.12). Vibration sensation recovered to 60%, whereas thermal sensation remained poor (19% at 5°C and 25% at 25°C).
Conclusions Finer sensation could be partially restored. However, thermal sensation remained poor.
*The two authors contributed equally to this work.
This article was presented at the 53rd Annual Meeting of the Swiss Society of Plastic, Reconstructive and Aesthetic Surgery, on September 1–2, 2017, in St. Moritz, Switzerland.
The authors would like to thank Selina Ackermann (Department of Surgery, University Hospital Basel, Switzerland) for organizational work and revising our manuscript.
Publication History
Received: 19 April 2019
Accepted: 23 August 2019
Article published online:
07 March 2022
© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
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REFERENCES
- 1 Sinis N, Lamia A, Gudrun H. et al. Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities. Neural Regen Res 2012; 7: 2279-85
- 2 Yildirim S, Gideroglu K, Akoz T. Anterolateral thigh flap: ideal free flap choice for lower extremity soft-tissue reconstruction. J Reconstr Microsurg 2003; 19: 225-33
- 3 Santanelli F, Tenna S, Pace A. et al. Free flap reconstruction of the sole of the foot with or without sensory nerve coaptation. Plast Reconstr Surg 2002; 109: 2314-22
- 4 Kuran I, Turgut G, Bas L. et al. Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area. Plast Reconstr Surg 2000; 105: 574-80
- 5 Yamauchi T, Yajima H, Kizaki K. et al. Sensory reconstruction in sensate radial forearm flap transfer. J Reconstr Microsurg 2000; 16: 593-5
- 6 Kalbermatten DF, Wettstein R, vonKanel O. et al. Sensate lateral arm flap for defects of the lower leg. Ann Plast Surg 2008; 61: 40-6
- 7 Tindholdt TT, Tonseth KA. Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction. Scand J Plast Reconstr Surg Hand Surg 2008; 42: 28-31
- 8 Kang MJ, Chung CH, Chang YJ. et al. Reconstruction of the lower extremity using free flaps. Arch Plast Surg 2013; 40: 575-83
- 9 Hattori Y, Chuang DC, Lan CT. Sensory restoration of the skin graft on a free muscle flap: experimental rabbit study. Plast Reconstr Surg 2001; 108: 132-40
- 10 Dayan JH, Lin CH, Wei FC. The versatility of the anterolateral thigh flap in lower extremity reconstruction. Handchir Mikrochir Plast Chir 2009; 41: 193-202
- 11 Shindo ML, Sinha UK, Rice DH. Sensory recovery in noninnervated free flaps for head and neck reconstruction. Laryngoscope 1995; 105 (12 Pt 1) 1290-3
- 12 Tremp M, Wettstein R, Raffoul W. et al. Secret scar free gracilis flap. J Reconstr Microsurg 2012; 28: 341-4
- 13 Tremp M, Wang W, Oranges CM. et al. Evaluation of the neo-umbilicus cutaneous sensitivity following abdominoplasty. Aesthetic Plast Surg 2017; 41: 1382-8
- 14 Aherrera AS, Pincus DJ, Vernadakis AJ. et al. Evaluation of abdominal cutaneous sensibility following abdominoplasty. Plast Reconstr Surg 2015; 135: 526e-32e
- 15 Waris T, Rechardt L, Kyosola K. Reinnervation of human skin grafts: a histochemical study. Plast Reconstr Surg 1983; 72: 439-47
- 16 Lee MJ, Yun IS, Rah DK. et al. Lower extremity reconstruction using vastus lateralis myocutaneous flap versus anterolateral thigh fasciocutaneous flap. Arch Plast Surg 2012; 39: 367-75
- 17 Demirtas Y, Neimetzade T, Kelahmetoglu O. et al. Comparison of free muscle and perforator skin flaps for soft tissue reconstruction of the foot and ankle. Foot Ankle Int 2010; 31: 53-8
- 18 Chang KN, DeArmond SJ, Buncke Jr HJ. Sensory reinnervation in microsurgical reconstruction of the heel. Plast Reconstr Surg 1986; 78: 652-64
- 19 Gordon L, Buncke HJ, Alpert BS. Free latissimus dorsi muscle flap with split-thickness skin graft cover: a report of 16 cases. Plast Reconstr Surg 1982; 70: 173-8
- 20 Bayramicli M, Jackson IT, Herschman B. Innervation of skin grafts over free muscle flaps. Br J Plast Surg 2000; 53: 130-6
- 21 Lahteenmaki T. The regeneration of adrenergic nerves in a free microvascular groin flap in the rat. Scand J Plast Reconstr Surg 1986; 20: 183-8
- 22 Lundborg G, Dahlin LB, Danielsen N. et al. Tissue specificity in nerve regeneration. Scand J Plast Reconstr Surg 1986; 20: 279-83