Sensory examination results of free flap repairs without nerve coaptation in lower extremity soft tissue defects

Heal with similar tissue is primary objective of plastic surgery. Oral cavity, breast skin, finger pulp, plantar foot areas are mostly reconstructing with innervated flaps. Sometimes there is no available recipient nerves in large tissue defects. Aim of this study is to share and discuss sensory examination of noninnervated free flaps. In November 2015, we recorded sensory examinations of patients, who had soft tissue defect at lower extremity, are treated with non innervated free flaps. 24 patients (16 male, 9 female), aged 18 to 65 (mean 38), follow up period is 10 to 126 months (mean 50,9). 15 free fascocutaneous, 9 free mucle flaps were performed. Light touch, pain, hot and cold discrimination, SW monofilament test performed all patients. SEP and DEP tests are performed to selected 10 patients. SEP test performed bilateral tibial nerves and DEP test performed flap tissue and equal tissue on the other leg. Flaps were divided 3 zones, peripheral, mid and central zones. Also perphery of flap tissue is examined via SW test. None of the patients felt the difference between hot and cold. Other examinations showed that peripheral zones are better than central zones. 16 of 24 patients had gained protective sensation (%64). 3 of 10 flaps were demonstrated cortical response with DEP. Nerve regeneration begin from periphery to flap center via axonal sprouting. Physical examination results support that theory. Periphrel zones showed better results than central zones. %64 of patient had gained protective sensation. When 2 patinets whom had anesthetic extremities are excluded, %70 of patients had protective sensation. DEP had never used for flap sensation. We found cortical response %30 of patinets. Although some patinets that had no response durind DEP were had good sensory examinations. We stimulate thick myelinated fibers with DEP. But patients perception did not depend only that fibers. Peripheral tissues are assisting for perception. We concluded the difference between DEP and sensory examination with this theory. We thınk that DEP test can show better resuts with larger groups and innervated flaps. As a result; innervated flaps are better options for soft tissue reconstructions, if there is a suitable recepient nerve. Mostly, there is no available nerves in large defects. Some sensory recory of reconstructed tissues should be remembered even reconstructed with non innervated free muscle or free fasciocutaneous flaps.