Abstract
Background The radial forearm free flap (RFFF) is widely used and is considered one of the workhorse
flaps in oncologic head and neck reconstructions. However, the potential for significant
donor-site morbidity remains a major drawback. Although various donor-site problems
have been reported, the incidence of neuropathic pain and possible predicting factors
remain unclear. This study aimed to identify the incidence, prognostic factors, and
impact on quality of life of neuropathic pain following RFFF harvest.
Methods In this multicenter, cross-sectional study, 167 patients who underwent an RFFF reconstruction
between 2010 and 2020 were included. Baseline characteristics were collected by medical
charts. All patients received questionnaires to measure patient's pain (Doleur Neuropathique
4 and visual analog scale, pain), hand function (Patient-Reported Wrist and Hand Evaluation),
and quality of life (EuroQol 5D). Multiple logistic regression was used to identify
prognostic factors associated with outcomes.
Results A total of 114 patients (68%) completed the questionnaire. Neuropathic pain was present
in 18% of all patients. Donor-site wound problems, mostly tendon exposure, occurred
in 32% and was significantly correlated with neuropathic pain (p = 0.003). Neuropathic pain was significantly associated with poorer quality of life
(p < 0.001) and poorer hand function (p < 0.001).
Conclusion Almost one-fifth of all patients deal with neuropathic pain following RFFF harvest.
Neuropathic pain is significantly correlated with poorer hand function and a poorer
quality of life. Therefore, future research should focus on analyzing surgical factors
such as the management of wound problems and primary denervation to improve hand function
and quality of life of these patients.
Keywords
donor-site morbidity - peripheral - nerve - radial forearm free flap - neuropathic
pain
