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Bruin LL, Hundepool CA, Duraku LS, Mureau MAM, Zuidam JM. Higher incidences of neuropathic pain and altered sensation following radial forearm free flap: A systematic review. J Plast Reconstr Aesthet Surg 2021; 75:1-9. [PMID: 34736849 DOI: 10.1016/j.bjps.2021.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/28/2021] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
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 therefore focus on the prognostic factors and preventive measures of neuropathic pain to further improve clinical outcomes of this widely used flap.
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Affiliation(s)
- L L Bruin
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C A Hundepool
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L S Duraku
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M A M Mureau
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J M Zuidam
- The Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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He J, Chen X, Yuan H, Zhang P, Jiang H, Wang K, Svensson P. Quantitative sensory testing of mandibular somatosensory function following orthognathic surgery-A pilot study in Chinese with class III malocclusion. J Oral Rehabil 2021; 49:160-169. [PMID: 34255881 DOI: 10.1111/joor.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Somatosensory changes after sagittal split ramus osteotomy (SSRO) have not been fully studied in Chinese patients by the latest technologies. OBJECTIVE To provide a comprehensive analysis of somatosensory function at the lower lip and chin at different time points following SSRO in a Chinese population. METHODS A total of 22 patients (18-27 years; nine men) with skeletal III malocclusion and scheduled for SSRO were recruited. Quantitative sensory testing (QST) was performed at pre-operation (baseline), 1 week (1W), 1, 3 and 6 months (1M, 3M, 6M) post-operatively. Cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT), mechanical pain threshold (MPT), pressure pain threshold (PPT) and two-point discrimination threshold (2PD) were tested at the lower lip and chin. RESULTS Except for PPT at both test sides at 1W and 1M, all QST values indicated a significantly reduced sensitivity (p < .05). All values had returned to baseline values at 3M with exception of HPT at the right chin which, however, had recovered at 6M (p > .05). CONCLUSIONS Somatosensory function at the lower lip and chin appears to be fully recovered in the majority of young Chinese adults 6 months after SSRO for skeletal class III malocclusion.
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Affiliation(s)
- Jiayi He
- Department of Oral and Maxillofacial Surgery & Department of Orofacial Pain and TMD, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Xin Chen
- Department of Oral and Maxillofacial Surgery & Department of Orofacial Pain and TMD, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Hua Yuan
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Ping Zhang
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Hongbing Jiang
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Kelun Wang
- Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
| | - Peter Svensson
- Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,KarolinskaInstitutet, Department of Dental Medicine, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
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Wang J, Zhu YQ, Wang Y, Xu HG, Xu WJ, Wang YX, Cheng XQ, Quan Q, Hu YQ, Lu CF, Zhao YX, Jiang W, Liu C, Xiao L, Lu W, Zhu C, Wang AY. A novel tissue engineered nerve graft constructed with autologous vein and nerve microtissue repairs a long-segment sciatic nerve defect. Neural Regen Res 2021; 16:143-149. [PMID: 32788469 PMCID: PMC7818853 DOI: 10.4103/1673-5374.286977] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Veins are easy to obtain, have low immunogenicity, and induce a relatively weak inflammatory response. Therefore, veins have the potential to be used as conduits for nerve regeneration. However, because of the presence of venous valves and the great elasticity of the venous wall, the vein is not conducive to nerve regeneration. In this study, a novel tissue engineered nerve graft was constructed by combining normal dissected nerve microtissue with an autologous vein graft for repairing 10-mm peripheral nerve defects in rats. Compared with rats given the vein graft alone, rats given the tissue engineered nerve graft had an improved sciatic static index, and a higher amplitude and shorter latency of compound muscle action potentials. Furthermore, rats implanted with the microtissue graft had a higher density and thickness of myelinated nerve fibers and reduced gastrocnemius muscle atrophy compared with rats implanted with the vein alone. However, the tissue engineered nerve graft had a lower ability to repair the defect than autogenous nerve transplantation. In summary, although the tissue engineered nerve graft constructed with autologous vein and nerve microtissue is not as effective as autologous nerve transplantation for repairing long-segment sciatic nerve defects, it may nonetheless have therapeutic potential for the clinical repair of long sciatic nerve defects. This study was approved by the Experimental Animal Ethics Committee of Chinese PLA General Hospital (approval No. 2016-x9-07) on September 7, 2016.
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Affiliation(s)
- Jing Wang
- Spine Research Center of Wannan Medical College, Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (Wannan Medical College), Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province; Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Ya-Qiong Zhu
- Department of Ultrasound, Chinese PLA General Hospital; Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing; Medical College of Nankai University, Tianjin, China
| | - Yu Wang
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing; The Neural Regeneration Co-Innovation Center of Jiangsu Province, Nantong, Jiangsu Province, China
| | - Hong-Guang Xu
- Spine Research Center of Wannan Medical College, Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (Wannan Medical College), Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Wen-Jing Xu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yue-Xiang Wang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Qing Cheng
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Qi Quan
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yong-Qiang Hu
- Department of Anesthesiology, the Second Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia Autonomous Region, China
| | - Chang-Feng Lu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yan-Xu Zhao
- Department of Orthopedic Surgery, Yan'an University Affiliated Hospital, Yan'an, Shaanxi Province, China
| | - Wen Jiang
- Department of Orthopedic Surgery, the First Affiliated Hospital of Medical College, Shihezi University, Shihezi, Xinjiang Uygur Autonomous Region, China
| | - Chen Liu
- Spine Research Center of Wannan Medical College, Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (Wannan Medical College), Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Liang Xiao
- Spine Research Center of Wannan Medical College, Key Laboratory of Non-coding RNA Transformation Research of Anhui Higher Education Institution (Wannan Medical College), Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui Province, China
| | - Wei Lu
- Department of Orthopedic Surgery, The First Peoples' Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Chen Zhu
- Department of Orthopedic Surgery, Anhui Provincial Hospital, The First Affiliated Hospital of University of Science and Technology of China, Heifei, Anhui Province, China
| | - Ai-Yuan Wang
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing; The Neural Regeneration Co-Innovation Center of Jiangsu Province, Nantong, Jiangsu Province, China
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Fan R, Gou H, Wang X, Li L, Xu Y, Svensson P, Wang K. Microcirculation and somatosensory profiling of patients with periodontitis: a preliminary case control report. Clin Oral Investig 2020; 25:1223-1233. [PMID: 32613435 DOI: 10.1007/s00784-020-03427-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purpose of this preliminary study was to explore blood microcirculation and somatosensory profiles in periodontitis patients before and after non-surgical periodontal therapy. MATERIALS AND METHODS Twenty patients (10 men and 10 women, 20 to 30 years old) and 20 age- and gender-matched healthy controls were included. Non-surgical periodontal therapy was performed for all patients. Clinical examination including pocket probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) were performed at baseline (BL), 1 week (1W), and 4 weeks (4W) after non-surgical periodontal therapy on 6 sites of tooth 32 and 42. Laser Doppler flowmetry (LDF) and quantitative sensory testing (QST) were applied at the attached gingiva of tooth 32 and 42 at BL, 1W, and 4W after non-surgical periodontal therapy. Data were analyzed with a two-way mixed-model of ANOVA. RESULTS The PPD, CAL and BOP significantly improved after non-surgical periodontal therapy (p < 0.001). Periodontitis patients demonstrated a higher tissue microvascular blood cell concentration (p = 0.015) and a significant gain in thermal (p = 0.037) and mechanical (p = 0.003) somatosensory function compared to controls. After non-surgical periodontal therapy, the flux (p = 0.002) and speed (p = 0.008) of blood flow decreased significantly and thermal (p = 0.029) and mechanical (p < 0.001) somatosensory function were reversed. CONCLUSION Gingival microcirculation and somatosensory function seem impaired in patients with periodontitis and are reversed following non-surgical periodontal therapy. CLINICAL RELEVANCE LDF and QST may be appropriate tools to further characterize gingival inflammation and treatment responses in periodontitis.
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Affiliation(s)
- Ruyi Fan
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, People's Republic of China
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China
| | - Huiqing Gou
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, People's Republic of China
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaoqian Wang
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China
| | - Lu Li
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yan Xu
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, People's Republic of China.
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China.
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Faculty of Odontology, Malmø University, Malmø, Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Kelun Wang
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, People's Republic of China
- Section of Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
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