Evaluation of Sensitivity of Radial Artery-Based Microsurgical Flaps
DOI:
https://doi.org/10.21270/archi.v14i1.6534Keywords:
Radial Artery, Microsurgery, Nerve, Stereognosis, Free Tissue FlapsAbstract
Background: The medical literature widely uses retrograde pedicled microsurgical flaps or free flaps without associated neurorrhaphy for coverage failures; however, complaints regarding loss of sensitivity in the recipient area are common. This study aims to evaluate the sensitivity of the radial artery-based antebrachial flaps in upper limb microsurgical procedures, to identify its reinnervation through tactile sensitivity. Methods: A retrospective-prospective study of patients undergoing reconstructive microsurgery with radial artery-based antebrachial flaps was conducted, and the return of sensitivity in the flap region was evaluated. For objective analysis, the Semmes-Weinstein monofilament esthesiometer was used. There was standardization and control of the perception of the monofilament from a point in the healthy area of the limb contralateral to the flap. The flap areas were divided into three regions (proximal, intermediate, and distal), and each was evaluated at three points (medial, intermediate, and lateral). From this, the results were classified as: (1) protective sensitivity, (2) partial sensitivity, and (3) loss of sensitivity. Results: 20 patients were included, aged between 19 and 75 years, with a mean age of 45 and a mean postoperative follow-up of 26.9 months. It was observed that 85% of the patients were male, with a high incidence of traumatic injuries (65%). Most coverage failures occurred in the wrist and hand region (75%). Regarding symptoms associated with the flap: 68.42% of the patients reported some complaint, with a predominance of paresthesia (66.66%), hypoesthesia (13.33%), Tinel (13.33%), and pain (6.66%). Analysis of the sensitivity of the flaps revealed significant differences between the proximal, intermediate, and distal regions. Proximal region: 90% of the patients presented sensitivity, with 35% showing protective sensitivity and 55% partial sensitivity (p < 0.001). Intermediate region: 95% presented partial sensitivity and 5% loss of sensitivity (p < 0.001). Distal region: 60% had a loss of sensitivity, 30% partial sensitivity, and 10% protective sensitivity (p < 0.001). Conclusion: Flap sensitivity varies in quantitative and qualitative terms, with a direct relationship with the location of the flap. Sensitivity decreases and vulnerability to injuries increases in the distal regions of the flap.
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