An approach to the prevention and treatment of neuropathic pain at the radial forearm phalloplasty donor site

Abstract

This article presents a comprehensive strategy for both the prevention and treatment of neuropathic pain at the radial forearm (RF) donor site. This strategy is presented within the framework of RF phalloplasty, based on the senior author’s practice and the premise that of all RF reconstructions, phalloplasty holds the greatest potential for postoperative neuropathic pain due to flap size and the inherent division of multiple antebrachial cutaneous nerves to provide for flap sensation. This proposed protocol offers a thorough care pathway that integrates techniques in peripheral nerve surgery with perioperative clinical strategies to prevent and treat neuropathic pain. Specific technical recommendations for the prevention and treatment of postoperative neuromas, compression neuropathies, and hyperalgesia of each peripheral nerve involved in RF phalloplasty flap harvest are proposed. These strategies can be adapted and applied to RF flaps utilized in other reconstructive areas.

Keywords

Radial forearm free flap / nerve pain / neuroma / phalloplasty / nerve allograft capping / targeted muscle innervation / regenerative peripheral nerve interfaces

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