Reinnervated lateral antebrachial cutaneous neurosome flaps in oral reconstruction: are we making sense?
Eight patients who underwent a partial glossectomy and associated floor of the mouth resection for squamous cell carcinoma were reconstructed with a sensate radial forearm flap in which the lateral antebrachial cutaneous nerve was anastomosed to the (divided) lingual nerve. The patients were compared prospectively with matched controls who received noninnervated forearm flaps for the same defect. A "blinded" therapist performed detailed sensory testing at least 6 months following surgery. In all modalities examined, the sensate proved superior to the nonsensate flap and not statistically different from the opposite side of the tongue. Two-point discrimination and pressure sensitivity were much greater in the innervated forearm flaps than in the forearms from which they came. The results are discussed with reference to the density of sensory receptors, the degree of cortical representation, and the subcortical anatomy of the neurosensory tracts. It appears that the density of sensory receptors is not directly related to the sensory potential in a given tissue transfer and that this potential is more related to the cortical fidelity of the recipient nerve. A historical matched cohort of 10 patients receiving pectoralis flaps for similar defects also was examined. Although the follow-up was longer, reinnervation was of a very low order--even worse than with noninnervated forearm flaps. This work supports the concept that sensory reinnervation should be attempted whenever possible following ablative oral surgery. This would include suture or grafting of major sensory nerves as well as the reinnervation of flaps.
Boyd
B
B
Toronto Hospital Head and Neck Unit, Ontario, Canada.
Mulholland
S
S
Gullane
P
P
Irish
J
J
Kelly
L
L
Rotstein
L
L
Brown
D
D
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005927:Glossectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000294:innervation / Q000601:surgery; D009062:Mouth Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D012677:Sensation; D012867:Skin / Q000294:innervation; D013524:Surgical Flaps / Q000379:methods