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Sensory assessment of meshed skin grafts over free gracilis muscle flaps without nerve coaptation for lower extremity reconstruction

Archives of Plastic Surgery 2021년 48권 2호 p.224 ~ 230
Tremp Mathias, Waldkircher Natascha J., Wang Wenjin, Oranges Carlo M., di Summa Pietro G., Zhang Yixin, Wang Wei, Schaefer Dirk J., Kalbermatten Daniel F.,
소속 상세정보
 ( Tremp Mathias ) - Basel University Hospital Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery
 ( Waldkircher Natascha J. ) - Basel University Hospital Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery
 ( Wang Wenjin ) - Shanghai Jiao Tong University School of Medicine Shanghai Ninth People’s Hospital Department of Plastic and Reconstructive Surgery
 ( Oranges Carlo M. ) - Basel University Hospital Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery
 ( di Summa Pietro G. ) - University Hospital of Lausanne Division of Plastic, Reconstructive and Aesthetic Surgery
 ( Zhang Yixin ) - Shanghai Jiao Tong University School of Medicine Shanghai Ninth People’s Hospital Department of Plastic and Reconstructive Surgery
 ( Wang Wei ) - Shanghai Jiao Tong University School of Medicine Shanghai Ninth People’s Hospital Department of Plastic and Reconstructive Surgery
 ( Schaefer Dirk J. ) - Basel University Hospital Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery
 ( Kalbermatten Daniel F. ) - Basel University Hospital Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery

Abstract


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.

키워드

Muscle flap; Nerve regeneration; Patient outcome assessment; Reconstruction; Sensation

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