REINNERVATED LATERAL ANTEBRACHIAL CUTANEOUS NEUROSOME FLAPS IN ORAL RECONSTRUCTION - ARE WE MAKING SENSE

Eight patients who underwent a partial glossectomy and associated floo r of the mouth resection for squamous cell carcinoma were reconstructe d with a sensate radial forearm flap in which the lateral antebrachial cutaneous nerve was anastomosed to the (divided) lingual nerve. The p atients were compared prospectively with matched controls who received noninnervated forearm flaps for the same defect. A ''blinded'' therap ist performed detailed sensory testing at least 6 months following sur gery. In all modalities examined, the sensate proved superior to the n onsensate 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 dens ity of sensory receptors, the degree of cortical representation, and t he subcortical anatomy of the neurosensory tracts. It appears that the density of sensory receptors is not directly related to the sensory p otential in a given tissue transfer and that this potential is more re lated to the cortical fidelity of the recipient nerve. A historical ma tched cohort of 10 patients receiving pectoralis flaps for similar def ects also was examined. Although the follow-up was longer, reinnervati on was of a very low order-even worse than with noninnervated forearm flaps. This work supports the concept that sensory reinnervation shoul d be attempted whenever possible following ablative oral surgery. This would include suture or grafting of major sensory nerves as well as t he reinnervation of flaps.