Analysis of Sensory Recovery of Neurotized Free Flaps in Cases of Head-Neck Reconstruction: Our Experience in a Tertiary Care Hospital.

Functional outcomes have been better concerning swallowing ability, distinguishing hot and cold sensations, articulation, and improved range of tongue movement by sensory neurotization of the flaps used for head and neck reconstruction. We evaluated the sensory recovery in free flaps utilizing the great auricular nerve as the recipient sensory nerve, anastomosing a few fascicles of the greater auricular nerve (GAN) to that of the flap sensory nerve; lateral antebrachial cutaneous nerve in the radial forearm free flap, and lateral femoral cutaneous nerve in the anterolateral thigh flap. The sensory examination was performed at the visible center of the flap at the three-month and six-month follow-ups. The flaps were assessed for the recovery of five sensory modalities: fine touch, pain, pressure, two-point discrimination (2PD), and temperature. The sensory recovery was evaluated according to the Mackinnon Dellon scale. The sensory recovery in the neurotized flaps was compared with that in non-neurotized free flaps at the six-month follow-up. The sensory recovery graded by the Mackinon Dellon scale for all five modalities of sensation was statistically significant in sensate-free flaps at the six-month follow-up. Also, the sensory territory of the greater auricular nerve at the peri-auricular area was assessed for loss of sensation at the six-month follow-up, which was not clinically significant. We observed the great auricular nerve as a potential sensory nerve that may be utilized at the flap reconstruction site to neurotize free flaps used for head and neck reconstruction with a significant sensory recovery and without worrisome symptoms at the GAN sensory territory.