Objective: To investigate the regularity of sensory recovery after repairing the wounds on the wrist and back of hand with anterolateral femoral flap without nerve anastomosis. Methods: A cross-sectional study was conducted. From January 2018 to December 2020, patients who underwent free anterolateral femoral flaps without nerve anastomosis to repair wounds on the wrist and back of hand and met the inclusion criteria in Changshu Hai Yu Health Centre and Suzhou Ruihua Orthopedic Hospital were included in this study. Depending on the time interval between the day of the patient's surgery and the day of the cross-sectional survey, 80 patients were divided into 6-month group (15 males and 5 females, aged 22-63 years), 12-month group (16 males and 4 females, aged 21-65 years), 18-month group (15 males and 5 females, aged 25-61 years), and 24-month group (14 males and 6 females, aged 20-65 years), with 20 patients in each group. The area of skin and soft tissue defects after debridement ranged from 6.0 cm×4.5 cm to 18.0 cm×9.0 cm. Anterolateral femoral flaps were cut with areas of 7 cm×5 cm to 20 cm×10 cm and a thickness of 1.0 to 2.5 cm. Each transplanted flap was divided into A (proximal), B/D (bilateral), C (distal), and E (central) regions. The pain sensation, touch sensation, cold sensation, warmth sensation, and two-point discrimination (2-PD) in the aforementioned five regions and the differences in the five senses of the whole flap were tested and compared. Data were statistically analyzed with one-way analysis of variance, Fisher's exact probability test, chi-square test, or McNemar test. Results: In A region of anterolateral femoral flap without nerve anastomosis, compared with those in 6-month group, the pain sensation, touch sensation, cold sensation, and warmth sensation of flap of patients in 12-month group were significantly recovered (with χ2 values of 10.10, 14.55, 12.13, and 4.29, respectively, P<0.05 or P<0.01); compared with that in 12-month group, the warmth sensation of flap of patients in 18-month group recovered significantly (χ2=5.23, P<0.05). In B region, compared with those in 6-month group, the pain sensation, touch sensation, and cold sensation of flap of patients in 12-month group recovered significantly (with χ2 values of 5.58, 3.96, and 4.29, respectively, P<0.05); compared with those in 12-month group, the pain sensation, touch sensation, cold sensation, and warmth sensation of flap of patients in 18-month group recovered significantly (with χ2 values of 5.58, 3.96, 7.03, and 12.38, respectively, P<0.05 or P<0.01). In C region, compared with that in 6-month group, the pain sensation of flap of patients in 12-month group recovered significantly (χ2=4.80, P<0.05); Compared with that in 12-month group, the warmth sensation of flap of patients in 18-month group recovered significantly (χ2=10.16, P<0.01). In D region, compared with those in 6-month group, the pain sensation, touch sensation, and cold sensation of flap of patients in 12-month group recovered significantly (with χ2 values of 5.58, 4.29, and 3.96, respectively, P<0.05); compared with those in 12-month group, the pain sensation, touch sensation, cold sensation, and warmth sensation of flap of patients in 18-month group recovered significantly (with χ2 values of 5.58, 4.29, 3.96, and 10.10, respectively, P<0.05 or P<0.01). In E region, compared with that in 6-month group, the cold sensation of flap of patients in 12-month group recovered significantly (χ2=4.80, P<0.05); compared with those in 12-month group, the pain sensation, touch sensation, and warmth sensation of flap of patients in 18-month group recovered significantly (with χ2 values of 6.47, 4.91, and 9.23, respectively, P<0.05 or P<0.01). The five senses in the 5 regions of flap of patients in 24-month group were similar to those in 18-month group (P>0.05). The recovery of 2-PD in the 5 regions of flap of patients was similar between the two adjacent groups (P>0.05). In 12-month group, the recoveries of pain sensation, touch sensation, and cold sensation of flap of patients in A region were better than those in the other 4 regions (P<0.05 or P<0.01), the recovery of warmth sensation was better than that of B region, C region, and E region (P<0.05 or P<0.01); in 18-month group, the recovery of pain sensation, touch sensation, cold sensation, and warmth sensation of flap of patients in A region of was better than those in area C region (P<0.05). Compared with those in 6-month group, the pain sensation, touch sensation, and cold sensation of the whole flap of patients in 12-month group recovered significantly (with χ2 values of 7.62, 7.03, and 5.58, respectively, P<0.05 or P<0.01). Compared with the 12-month group in which 10, 11, 10, and 4 patients had a recovery of pain, touch sensation, cold sensation, and warmth sensation in the whole flap, the 18-month group had significantly more patients with sensations recovered, which were 17, 17, 16, and 14, respectively (with χ2 values of 5.58, 4.29, 3.96, and 10.10, respectively, P<0.05 or P<0.01). The five senses of the whole flap of patients in 24-month group were similar to those in 18-month group (P>0.05). Conclusions: In the anterolateral femoral flap without nerve anastomosis for repairing wounds on the wrist and back of hand, the sensation gradually recovered from the proximal end to the distal end. The sensation of touch, pain, and cold began to recover from 6 months after operation, and entered the stable recover period at 18 months after operation. Warmth sensation began to recover from 12 months after operation, and entered the stable recovery period at 18 months after operation. The 2-PD of most flaps was still not recovered 2-year after operation.
目的： 探讨无神经吻合的股前外侧皮瓣修复手腕及手背部创面后感觉恢复规律。 方法： 采用横断面研究方法。将2018年1月—2020年12月在江苏省常熟市海虞卫生院和苏州瑞华骨科医院采用无神经吻合的股前外侧皮瓣游离移植修复手腕及手背部创面的且符合入选标准的患者纳入本研究。根据患者手术日与横断面调查日之间的时间间隔，将80例患者分为6个月组（男15例、女5例，年龄22~63岁）、12个月组（男16例、女4例，年龄21~65岁）、18个月组（男15例、女5例，年龄25~61岁）、24个月组（男14例、女6例，年龄20~65岁），每组20例。患者清创后的皮肤软组织缺损面积为6.0 cm×4.5 cm~18.0 cm×9.0 cm，股前外侧皮瓣切取面积为7 cm×5 cm~20 cm×10 cm、厚度为1.0~2.5 cm。将移植后皮瓣分为A区（近心端）、B/D区（两侧）、C区（远端）和E区（中央区域）。测试并比较前述5个区的痛觉、触觉、冷觉、温觉和两点辨别觉（2-PD）及整个皮瓣5种感觉的差异。对数据行单因素方差分析、Fisher确切概率法检验、χ2检验或McNemar检验。 结果： 无神经吻合的股前外侧皮瓣A区中，与6个月组相比，12个月组患者皮瓣的痛觉、触觉、冷觉、温觉均恢复明显（χ2值分别为10.10、14.55、12.13、4.29，P<0.05或P<0.01）；与12个月组相比，18个月组患者皮瓣的温觉恢复明显（χ2=5.23，P<0.05）。B区中，与6个月组相比，12个月组患者皮瓣的痛觉、触觉、冷觉均恢复明显（χ2值分别为5.58、3.96、4.29，P<0.05）；与12个月组相比，18个月组患者皮瓣的痛觉、触觉、冷觉、温觉均恢复明显（χ2值分别为5.58、3.96、7.03、12.38，P<0.05或P<0.01）。C区中，与6个月组相比，12个月组患者皮瓣的痛觉恢复明显（χ2=4.80，P<0.05）；与12个月组相比，18个月组患者皮瓣的温觉恢复明显（χ2=10.16，P<0.01）。D区中，与6个月组相比，12个月组患者皮瓣的痛觉、触觉、冷觉均恢复明显（χ2值分别为5.58、4.29、3.96，P<0.05）；与12个月组相比，18个月组患者皮瓣的痛觉、触觉、冷觉、温觉均恢复明显（χ2值分别为5.58、4.29、3.96、10.10，P<0.05或P<0.01）。E区中，与6个月组相比，12个月组患者皮瓣的冷觉恢复明显（χ2=4.80，P<0.05）；与12个月组相比，18个月组患者皮瓣的痛觉、触觉、温觉均恢复明显（χ2值分别为6.47、4.91、9.23，P<0.05或P<0.01）。24个月组患者皮瓣5个区的5种感觉与18个月组均相似（P>0.05）。各相邻2组间，患者皮瓣5个区的2-PD恢复情况均近似（P>0.05）。12个月组患者皮瓣A区的痛觉、触觉、冷觉恢复均明显优于其他4个区（P<0.05或P<0.01），温觉恢复明显优于B区、C区、E区（P<0.05或P<0.01）；18个月组患者皮瓣A区的痛觉、触觉、冷觉、温觉恢复明显优于C区（P<0.05）。与6个月组相比，12个月组患者整个皮瓣的痛觉、触觉、冷觉均恢复明显（χ2值分别为7.62、7.03、5.58，P<0.05或P<0.01）；与12个月组患者整个皮瓣的痛觉、触觉、冷觉、温觉恢复者分别有10、11、10、4例相比，18个月组患者的17、17、16、14例均明显增多（χ2值分别为5.58、4.29、3.96、10.10，P<0.05或P<0.01）。24个月组患者整个皮瓣的5种感觉与18个月组均相似（P>0.05）。 结论： 在修复手腕及手背部创面的无神经吻合的股前外侧皮瓣中，感觉从近端逐渐向远端恢复；其中整个皮瓣的触觉、痛觉、冷觉从术后6个月即开始恢复，至术后18个月进入恢复稳定期；温觉从术后12个月开始恢复，至术后18个月进入恢复稳定期；而大多数皮瓣的2-PD在术后2年仍未恢复。.