Neuropathic Donor-Site Pain following Radial Forearm Free Flap Harvest: A Multicenter Study on Incidence, Prognostic Factors, and Quality of Life.

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.

[Limping in toddlers due to disorders of the spine and spinal cord]. / Mank lopen bij peuters door afwijkingen aan de wervelkolom en het ruggenmerg.

Limping is a frequent symptom during childhood and can be caused by a variety ofdiseases, the most common causes being trauma and infections of the bones or joints. The authors describe three cases of limping in toddlers caused by infrequent spinal diseases. The toddlers presented with limping without a preceding trauma. In the first patient, an 18-month-old girl, the limping was caused by spondylodiscitis. She recovered completely after antibiotics. The second patient, a 13-month-old boy, presented with limping caused by neuroblastoma with extensive bone metastasis. Despite chemotherapy and partial resection of the neuroblastoma, the boy did not survive. In the last patient, a 19-month-old girl, the limping was caused by an intraspinal intramedullary astrocytoma. She recovered after partial resection of the tumour. In young children presenting with limping, diagnoses involving the spine should also be considered because early intervention can influence the prognosis favourably.