Abstract：
BACKGROUND: Skin-grafted free gracilis muscle flaps are commonly used for lower extremity reconstruction. However, the loss of sensory function may lead to increased patient morbidity. This study prospectively analyzed the sensory and neuropathic pain outcomes of neurotized skin-grafted free gracilis muscle flaps used for the reconstruction of lower extremity defects.
METHODS: Patients undergoing lower extremity reconstructions between 2020 and 2022 with neurotized skin-grafted free gracilis muscle flaps were prospectively enrolled. Sensation was assessed at 3, 6 and 12 months postoperatively using monofilaments, two-point discrimination, a vibration device, and cold and warm metal rods. Sensations were tested in the center and periphery of the flaps, as well as in the surrounding skin. The contralateral side served as the control. Patients completed the McGill pain questionnaire to evaluate patient-reported neuropathic pain.
RESULTS: Ten patients were included. At 12 months postoperatively, monofilament values improved by 44.5% compared to that of the control site, two-point discrimination, cold detection, warmth detection, and vibration detection improved by 36.2%, 48%, 50%, and 88.2%, respectively, at the reconstructed site compared to those at the control site. All sensory tests were significantly better than 3 and 6 months values (p < 0.05), but remained significantly poorer than the control site (p < 0.05). Sensation in the central flap areas were similar to peripheral flap areas throughout the follow-up period (p > 0.05). The surrounding skin reached values similar to the control site at 12 months (p > 0.05). Moreover, 50% of patients reported neuropathic pain at 3 months postoperatively, 40% at 6 months, and 0% at 12 months (p < 0.05).
CONCLUSIONS: Mechanical detection, vibration detection, temperature detection, and two-point discrimination significantly improved over time but without reaching normal sensory function at 12 months postoperatively. Neuropathic pain resolved at 12 months.
METHODS: Patients undergoing lower extremity reconstructions between 2020 and 2022 with neurotized skin-grafted free gracilis muscle flaps were prospectively enrolled. Sensation was assessed at 3, 6 and 12 months postoperatively using monofilaments, two-point discrimination, a vibration device, and cold and warm metal rods. Sensations were tested in the center and periphery of the flaps, as well as in the surrounding skin. The contralateral side served as the control. Patients completed the McGill pain questionnaire to evaluate patient-reported neuropathic pain.
RESULTS: Ten patients were included. At 12 months postoperatively, monofilament values improved by 44.5% compared to that of the control site, two-point discrimination, cold detection, warmth detection, and vibration detection improved by 36.2%, 48%, 50%, and 88.2%, respectively, at the reconstructed site compared to those at the control site. All sensory tests were significantly better than 3 and 6 months values (p < 0.05), but remained significantly poorer than the control site (p < 0.05). Sensation in the central flap areas were similar to peripheral flap areas throughout the follow-up period (p > 0.05). The surrounding skin reached values similar to the control site at 12 months (p > 0.05). Moreover, 50% of patients reported neuropathic pain at 3 months postoperatively, 40% at 6 months, and 0% at 12 months (p < 0.05).
CONCLUSIONS: Mechanical detection, vibration detection, temperature detection, and two-point discrimination significantly improved over time but without reaching normal sensory function at 12 months postoperatively. Neuropathic pain resolved at 12 months.
摘要：
背景：皮肤移植游离股薄肌皮瓣通常用于下肢重建。然而,感觉功能的丧失可能导致患者发病率增加。这项研究前瞻性地分析了用于重建下肢缺损的神经化皮肤移植游离股薄肌皮瓣的感觉和神经性疼痛结果。
方法：前瞻性纳入2020年至2022年期间接受神经化皮肤移植游离股薄肌瓣重建下肢的患者。使用单丝在术后3、6和12个月评估感觉，两点歧视，振动装置，冷和温暖的金属棒。在皮瓣的中心和周围测试了感觉，以及周围的皮肤。对侧作为对照。患者完成McGill疼痛问卷以评估患者报告的神经性疼痛。
结果：纳入10例患者。术后12个月，与对照组相比，单丝值提高了44.5%，两点歧视，冷检测,温暖检测，振动检测提高了36.2%，48%,50%,和88.2%，分别,在重建地点与控制地点相比。所有感官测试均明显优于3个月和6个月的值（p<0.05），但仍显著低于对照组(p<0.05)。在整个随访期间，中央皮瓣区域的感觉与周围皮瓣区域相似（p>0.05）。在12个月时,周围皮肤达到与对照部位相似的值(p>0.05)。此外，50％的患者在术后3个月报告神经性疼痛，6个月时40%,12个月时为0%(p<0.05)。
结论：机械检测，振动检测，温度检测,两点辨别随着时间的推移显着改善，但术后12个月未达到正常的感觉功能。神经性疼痛在12个月时缓解。
方法：前瞻性纳入2020年至2022年期间接受神经化皮肤移植游离股薄肌瓣重建下肢的患者。使用单丝在术后3、6和12个月评估感觉，两点歧视，振动装置，冷和温暖的金属棒。在皮瓣的中心和周围测试了感觉，以及周围的皮肤。对侧作为对照。患者完成McGill疼痛问卷以评估患者报告的神经性疼痛。
结果：纳入10例患者。术后12个月，与对照组相比，单丝值提高了44.5%，两点歧视，冷检测,温暖检测，振动检测提高了36.2%，48%,50%,和88.2%，分别,在重建地点与控制地点相比。所有感官测试均明显优于3个月和6个月的值（p<0.05），但仍显著低于对照组(p<0.05)。在整个随访期间，中央皮瓣区域的感觉与周围皮瓣区域相似（p>0.05）。在12个月时,周围皮肤达到与对照部位相似的值(p>0.05)。此外，50％的患者在术后3个月报告神经性疼痛，6个月时40%,12个月时为0%(p<0.05)。
结论：机械检测，振动检测，温度检测,两点辨别随着时间的推移显着改善，但术后12个月未达到正常的感觉功能。神经性疼痛在12个月时缓解。
