Sensory topography of the oral cavity and the impact of free flap reconstruction: A preliminary study

Evaluating Sensation Recovery in Noninnervated Free Flaps Used for Oral Reconstruction

PURPOSE

Association between time and sensation recovery in noninnervated flaps remains unclear. Our goal was to evaluate the recovery of sensation in noninnervated free flaps used for oral reconstruction.

MATERIALS AND METHODS

A prospective cohort study was designed and consecutive patients undergoing noninnervated free flap surgery for oral reconstruction from a tertiary medical center were enrolled. The primary outcome variable was sensory recovery of light touch, pain, hot, and cold temperature. Sensory recovery was scored as per the test on the central portion and 4 peripheral sections of every flap. The Kaplan-Meier method was used to estimate the functional recovery at different time points and the association between clinicopathologic variables and sensation recovery at 24 months after surgery was analyzed using the chi-squared test and logistic regression analysis.

RESULTS

Eighty patients were included with a median age of 50 years. At 3 months postoperatively, no patients exhibited sensation recovery. Positive flap sensitivity began to appear mildly at 6 months postoperatively and gradually increased for at least 24 months. The 24-month sensation recovery rates of light touch, pain, and temperature were 70.0% (95% confidence interval [CI]: 59.2 to 78.9%), 42.5% (95% CI: 32.3 to 53.4%), and 33.8% (95% CI: 24.45 to 44.6%), respectively. In univariate analysis, 80.5% (95% CI: 66.0 to 89.8%) of the free radial forearm flaps showed light touch sensation recovery, which was statistically higher than 59.0% (95% CI: 43.4 to 72.9%) in other flaps (P = .036). Flap size ≤ 65 cm² predicted better pain sensation recovery with 57.5% (95% CI: 42.2 to 71.5%) compared to 27.5% (95% CI: 16.1 to 42.8%) in flap size > 65 cm² groups (P = .007). Logistic regression analysis confirmed flap size ≤ 65 cm² (P = .032, odds ratio = 1.957, 95% CI: 1.034 to 4.389) and not smoking (P = .015, odds ratio = 2.564, 95% CI: 1.673-5.482) offered better sensation recovery of pain and hot temperature, respectively.

CONCLUSIONS

Sensation recovery in noninnervated free flaps was common and related to not smoking and flap size.

Comparison of Shoulder Management Strategies after Stage I of Fingertip Skin Defect Repair with a Random-Pattern Abdominal Skin Flap

BACKGROUND

In the absence of scientific evidence regarding the effectiveness of shoulder management strategies after stage I of fingertip reconstruction, the purpose of this study was to compare the clinical outcomes of various rehabilitation procedures.

MATERIAL AND METHODS

Patients who underwent fingertip reconstruction with a random-pattern abdominal skin flap between March 2007 and February 2013 were enrolled in the study (n=95). Thirty performed only active exercise (group A), 29 performed only passive exercise (group B), and 32 received a combination of active exercise and pulsed electromagnetic field (PEMF) (group C). The mean age at the time of treatment was 30.2 years in group A, 29.6 years in group B, and 31.8 years in group C.

RESULTS

At the final follow-up, there were significant differences between group A and B in terms of Constant score (P=.001), VAS (P=.047), forward flexion of the shoulder (P=0.049), and muscle strength with forward flexion and external rotation (P=0.049 and P=0.042, respectively). A higher Constant score was observed in group C compared to group A, and although there were no differences in the other evaluations between groups A and C, a trend toward better function of the shoulder was demonstrated in group C.

CONCLUSIONS

The most important findings in our study are that a combination of active exercise and PEME produces superior patient-reported outcomes regarding relief of shoulder signs and symptoms. Given the limitations of this study, better-designed studies with large sample sizes and long-term follow-up are required.

Functional sensory function recovery of random-pattern abdominal skin flap in the repair of fingertip skin defects

The fingertip skin defect is a common hand injury often accompanied by tendon or bone exposure, and is normally treated with flaps. The aim of this study was to evaluate the functional sensory recovery of random-pattern abdominal skin flap in the repair of fingertip cutaneous deficiency. A total of 23 patients, aged between 18 and 50 years (mean age, 31 years) with fingertip cutaneous deficiency (30 digits) were treated with random-pattern abdominal skin flaps. The post-debridement defect area measured from 0.7×1.2 to 2.5×3 cm. The flap pedicle was divided three weeks after surgery, which marked the onset of the second stage. A second surgery was performed on 2 patients after 3 months and on another set of 2 patients after 6 months to create a thinner flap. Tissue was dissected during surgery for a histological examination. All the flaps survived and the post-operative follow-up ranged from 2 weeks to 6 months. Patients were satisfied with the appearance of their fingers and the flaps. All flaps demonstrated satisfactory flexibility and texture and sensory recovery was achieved. Only 4 patients were subjected to a second surgery to make the flap thinner. The flaps for the 3-month tissue section had several low-density, free nerve endings, whereas those of the 6-month section had more intensive free nerve endings, nerve tracts, tactile cells and lamellar corpuscles. Random-pattern abdominal skin flap therefore repairs fingertip skin defects achieving sensory recovery.