{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T01:55:23Z","timestamp":1778723723002,"version":"3.51.4"},"reference-count":33,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Objectives: Free gracilis (GM) and latissimus dorsi muscle (LDM) flaps are reliable options for complex defect coverage, but long-term sensory outcomes remain underexplored. Sensory impairment, especially the loss of protective cutaneous sensation, increases the risk of injury, thermal damage, and ulceration in reconstructed areas. This study aimed to systematically assess multidimensional sensory recovery after free muscle flap (FMF) reconstruction. Methods: In a prospective single-center study, 94 patients (49 GM, 45 LDM) underwent standardized sensory testing following FMF transfer. Five modalities were evaluated: pressure detection (Semmes-Weinstein monofilaments), vibration perception, two-point discrimination (2PD), sharp\u2013dull differentiation, and temperature differentiation. Measurements were compared to contralateral healthy skin (CHS). Subgroup analyses were performed by anatomical region (head, trunk, extremities). Results: All sensory modalities were significantly impaired in FMF compared to CHS (p &lt; 0.0001). Mean pressure thresholds were markedly higher in FMF (248.8 g) versus CHS (46.8 g). Vibration perception scores were reduced (FMF 3.97 vs. CHS 5.31), and 2PD was significantly poorer (11.6 cm vs. 4.7 cm). Sharp\u2013dull and thermal discrimination were largely absent in FMF (positivity rates &lt; 20%), with 58.5% of patients demonstrating only deep pressure sensation (\u2265300 g). No significant differences were found between GM and LDM in most modalities, except for worse 2PD in GM. Subgroup analyses confirmed uniform deficits across all anatomical regions. Conclusions: FMFs without neurotization result in profound, persistent sensory deficits, particularly the loss of protective sensation. Clinically, fascio-cutaneous flaps with nerve coaptation should be considered in functionally critical regions. Future strategies should focus on neurotization techniques to enhance sensory recovery.<\/jats:p>","DOI":"10.3390\/medsci13040262","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T14:55:15Z","timestamp":1762527315000},"page":"262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sensory Recovery After Free Muscle Flap Reconstruction\u2014A Clinical Study of Protective and Discriminative Function of Free Gracilis and Latissimus Dorsi Muscle Flaps Without Neurotization"],"prefix":"10.3390","volume":"13","author":[{"given":"Maximilian C.","family":"Stumpfe","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital, Paracelsus Medical University, Breslauerstrasse 201, 90471 Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3614-9600","authenticated-orcid":false,"given":"Moritz","family":"Billner","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital, Paracelsus Medical University, Breslauerstrasse 201, 90471 Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Hellweg","sequence":"additional","affiliation":[{"name":"Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Hirschmann","sequence":"additional","affiliation":[{"name":"Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rakan R.","family":"Al-Turki","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital, Paracelsus Medical University, Breslauerstrasse 201, 90471 Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celena A.","family":"S\u00f6rgel","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital, Paracelsus Medical University, Breslauerstrasse 201, 90471 Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vadym","family":"Burchak","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital, Paracelsus Medical University, Breslauerstrasse 201, 90471 Nuremberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3746-7838","authenticated-orcid":false,"given":"Nikolaus","family":"Wachtel","sequence":"additional","affiliation":[{"name":"Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9394-8412","authenticated-orcid":false,"given":"Denis","family":"Ehrl","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital, Paracelsus Medical University, Breslauerstrasse 201, 90471 Nuremberg, Germany"},{"name":"Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Marchioninistra\u00dfe 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1097\/SCS.0000000000009176","article-title":"Forgotten Pioneers of Plastic and Reconstructive Surgery During the Medieval Period","volume":"34","author":"Atiyeh","year":"2023","journal-title":"J. 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