{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T21:11:41Z","timestamp":1787087501529,"version":"build-2736575974"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003The radial forearm free flap (RFFF) is a staple of microsurgical reconstruction. Significant attention has been paid to donor-site morbidity, particularly vascular and aesthetic consequences. Relatively few authors have discussed peripheral nerve morbidity such as persistent hypoesthesia, hyperesthesia, or allodynia in the hand and wrist or neuroma formation in the wrist and forearm. Here, we present a diagnostic and therapeutic algorithm for painful neurologic complications of the RFFF donor site.<\/jats:p><jats:p>\n          Materials and Methods\u2003The peripheral nerves that can be involved with the RFFF are reviewed with respect to the manner in which they may be involved in postoperative pain manifestations. A method for prevention and for treatment of each of these possibilities is also presented.<\/jats:p><jats:p>\n          Results\u2003Nerves from the forearm that can be harvested with the RFFF will have the most likelihood for injury and these include the lateral antebrachial cutaneous nerve, the radial sensory nerve, and the medial antebrachial cutaneous nerve. A nerve that may be injured at the distal juncture of the skin graft to the forearm is the palmar cutaneous branch of the median nerve. The \u201cprevention\u201d portion of the algorithm suggests that each nerve divided to become a recipient nerve should have its proximal end implanted into a muscle to prevent painful neuroma. The \u201ctreatment\u201d portion of the algorithm suggests that if a neuroma does form, it should be resected, not neurolysed, and the proximal portion should be implanted into an adjacent muscle. The diagnostic role of nerve block is emphasized.<\/jats:p><jats:p>\n          Conclusion\u2003Neurological complications following RFFF can be prevented by an appropriate algorithm as described by devoting attention to the proximal end of recipient nerves. Neurological complications, once present, can be difficult to diagnose accurately. Nerve blocks are critical in this regard and are employed in the treatment algorithm presented.<\/jats:p>","DOI":"10.1055\/s-0040-1714149","type":"journal-article","created":{"date-parts":[[2020,7,29]],"date-time":"2020-07-29T22:49:52Z","timestamp":1596062992000},"page":"680-685","source":"Crossref","is-referenced-by-count":9,"title":["An Algorithm for the Prevention and Treatment of Pain Complications of the Radial Forearm Free Flap Donor Site"],"prefix":"10.1055","volume":"36","author":[{"given":"Nicholas A.","family":"Calotta","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akash","family":"Chandawarkar","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun C.","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Lee","family":"Dellon","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland"},{"name":"Dellon Institutes for Peripheral Nerve Surgery, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,7,29]]},"reference":[{"issue":"03","key":"ref1","first-page":"162","article-title":"Forearm free skin flap transplantation: a report of 56 cases. 1981","volume":"50","author":"G F Yang","year":"1997","journal-title":"Br J Plast Surg"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/0007-1226(88)90044-6","article-title":"Phalloplasty using the free radial forearm flap","volume":"41","author":"B A Matti","year":"1988","journal-title":"Br J Plast Surg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1080\/2000656X.2018.1537977","article-title":"Aesthetic improvements of radial forearm flap donor site by autologous fat transplantation","volume":"53","author":"B Longo","year":"2019","journal-title":"J Plast Surg Hand Surg"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1097\/00006534-199008000-00014","article-title":"Reducing morbidity in the radial forearm flap donor site","volume":"86","author":"A F Bardsley","year":"1990","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref5","doi-asserted-by":"crossref","first-page":"E262","DOI":"10.1002\/hed.23111","article-title":"Abnormal anatomy of the superficial branch of the radial nerve","volume":"35","author":"R H Lindau","year":"2013","journal-title":"Head Neck"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/S0363-5023(09)91056-5","article-title":"The superficial branch of the radial nerve: an anatomic study with surgical implications","volume":"17","author":"R A Abrams","year":"1992","journal-title":"J Hand Surg Am"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/00000637-200044040-00004","article-title":"Neural anatomy of the radial forearm flap","volume":"44","author":"S Boutros","year":"2000","journal-title":"Ann Plast Surg"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/S0363-5023(85)80076-9","article-title":"The overlap pattern of the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve","volume":"10","author":"S E Mackinnon","year":"1985","journal-title":"J Hand Surg Am"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0266-7681(85)80011-5","article-title":"Injury to the medial antebrachial cutaneous nerve during cubital tunnel surgery","volume":"10","author":"A L Dellon","year":"1985","journal-title":"J Hand Surg [Br]"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0363-5023(86)80051-X","article-title":"Radial sensory nerve entrapment in the forearm","volume":"11","author":"A L Dellon","year":"1986","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref11","first-page":"196","article-title":"Classical article: Cheiralgia paresthetica (entrapment of the radial nerve). 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