A quantitative analysis of microcirculation during healing of split-thickness skin grafts in standardized full-thickness wounds.

BACKGROUND: Full-thickness skin defects often are managed with split-thickness skin grafting. The wound healing process, including formation of new vessels during the healing of skin grafts, is complex. OBJECTIVE: To evaluate the microcirculatory changes in the treated tissue after skin grafting to analyze perfusion dynamics during the wound healing process. MATERIALS AND METHODS: Fourteen full-thickness skin defects were created on the back of 14 adult male Lewis rats. All wounds were treated with autologous split-thickness skin grafts. The perfusion dynamics were assessed for 84 days with an O2C device that combines a laser light to determine blood flow and white light to determine postcapillary SO2 and the rHb. RESULTS: Blood flow increased for 50 days after grafting. SO2 decreased in superficial skin layers (depth of 2 mm) and increased in deep skin layers (depth of 8 mm) during the entire observation period. The rHb increased until day 10 in superficial layers and until day 20 in deep tissue layers. CONCLUSION: The microcirculatory changes reflect the different phases of wound healing. Long after the skin transplants were macroscopically healed, alterations in microcirculation were still detected. These alterations were caused by the long-lasting changes in tissue metabolism due to the formation, conversion, and degradation of the dermal matrix and vessels during wound healing and scar formation.

[Rhizarthrosis: Resection Arthroplasty versus Resection Suspension Arthroplasty - Still the Gold Standard?] / Rhizarthrose: Resektionsarthroplastik versus Resektionssuspensionsarthroplastik ­ immer noch der Goldstandard?

Rhizarthrosis is one of the most common arthritic changes in the hand, which has led to the development of a large number of surgical methods in recent years. In addition to the traditional resection arthroplasty with tendon suspension or interposition, if needed, thumb saddle joint prostheses are being used more and more frequently. However, these are not an option for all patients such as those with severe osteoporosis, severe nickel allergy, insufficient height of the trapezium or STT osteoarthritis. This study examined whether the traditional surgical methods continue to have their "right to exist" or whether they will be replaced by prostheses. In a retrospective study with prospective data collection, 48 hands of 45 patients diagnosed with rhizarthrosis in stages II and III according to Eaton and Littler were clinically examined 2.5 years after resection arthroplasty/resection-suspension-interposition arthroplasty using flexor carpi radialis (FCR) or abductor pollicis longus (APL) tendon strips in the years 2015-2018. The postoperative outcome was assessed using mobility, grip strength, two-point discrimination, postoperative satisfaction with regard to pain and resilience, as well as the DASH and MHQ questionnaires. There were no significant differences in surgery duration, inability to work, time to full weight-bearing, pain, satisfaction, grip strength and mobility. Regardless of the surgical method used, patients achieved an almost free range of motion in the thumb and wrist as well as age-appropriate hand strength. Pain at rest was rare; 48% were pain-free during exercise. The DASH questionnaire scored 20.2, 13.9 and 22.1 points and the MHQ scored 76.3, 79.3 and 79.4 points. Hence, the traditional surgical techniques showed good postoperative results with high patient satisfaction. "Newer procedures" such as endoprosthesis offer promising results in terms of faster regeneration times. However, this is offset by a longer surgery time and higher material costs, which means that resection arthroplasty represents a long-established procedure with a low potential for complications and a lower revision rate and should continue to be used, especially if there are relative contraindications to an endoprosthesis.

The Impact of Blue Light Irradiation on Keratinocytes in Vitro.

BACKGROUND: This study examined the effects of irradiation with blue light on HaCaT keratinocytes. As irradiation with blue light is known to be antimicrobial, it offers a promising alternative therapy for contaminated wounds. There is evidence that red light promotes wound healing, but the potential benefits of irradiation with blue light have not yet been adequately investigated. METHODS: The rate of wound closure in sterile and contaminated cells was measured using an in vitro scratch assay wound-healing model. Additionally, cell viability after treatment was determined using a Sulforhodamine B (SRB) assay. RESULTS: In both the sterile and contaminated groups, treated cells showed delayed wound closure when compared with cells not irradiated with blue light. Additionally, treatment with blue light resulted in poorer viability in the treatment groups. CONCLUSION: Although irradiation with blue light may offer a promising alternative therapy for reducing bacterial colonization, our data indicate that re-epithelization may be negatively influenced by blue light. Further research is needed to clarify possible wound healing applications.

Quantification of Dermal Microcirculatory Changes after Topical Administration of Capsaicin: A Randomized Placebo-Controlled Study in 46 Subjects.

BACKGROUND: Dermal blood flow is crucial for wound healing and survival of flaps in dermatologic surgery. To improve flap viability in cases of compromised perfusion topical agents can easily be applied. The aim of this placebo-controlled study was to characterize changes of DBF in healthy subjects by quantitatively assessing perfusion dynamics after application of capsaicin to establish a reference for measurements at injured sites. METHODS: In 46 healthy subjects perfusion dynamics after local application with capsaicin and placebo was noninvasively assessed, determining cutaneous oxygen saturation, relative hemoglobin count and blood flow using an Oxygen-to-See device. RESULTS: A significant raise in superficial (162% p = 0.000) and deep (144%, p = 0.000) skin oxygenation after 30 min was provoked. A highly significant raise in measurements of flow and velocity was present in superficial (523%, p = 0.000) and deep (242%, p = 0.000) sites. CONCLUSION: With the introduced model applied to observe changes in parameters of dermal blood flow in healthy subjects the authors can reliably monitor effects of topically administered capsaicin. This baseline can be used as reference for further studies in the settings of endangered flap survival or critically perfused wounds as has been proven in animal studies.

Immune-modulating properties of blue light do not influence reepithelization in vitro.

Phototherapy is gaining more attention in the treatment of various diseases. Especially, blue light seems to be a promising approach for wound healing promotion due to its antimicrobial and immune-modulating properties. Despite this, there is only little research focusing on the immune-modulating properties of blue light and its possible effects on wound healing. Therefore, we investigated the effects of blue light irradiation on peripheral blood mononuclear cells (PBMC) and the influence on reepithelization in vitro. PBMCs were irradiated with DermoDyne® (DermoDyne HealthCare, Berlin, Germany) and effects on cell viability, cytokine expression, and scratch wound closure were evaluated afterwards. Irradiated cells showed a higher Interleukin-γ concentration while irradiation reduced resazurin concentration in a time-dependent manner. No differences in reepithelization were detectable when keratinocytes were treated with the supernatant of these blue light irradiated PBMCs. Blue light-mediated ex vivo stimulation of PBMCs does not cause faster reepithelization in an in vitro setting. Further research is needed to investigate the wound healing effects of phototherapy with blue light.

The Influence of Topically Administered Heparin on Peripheral Microcirculation of the Skin: A Double-Blind, Randomized, Controlled Preliminary Study on 50 Healthy Subjects.

BACKGROUND: Venous thrombosis is the most common cause of flap failure in the first days after surgery. Although heparin is one of the most important antithrombotic substances and is implemented in the therapy of various diseases, there are only a few studies addressing its topical administration in the field of flap surgery. Especially, very little is known about the effects of topical heparin and its impact on microcirculation. In this study we evaluated to what extent topically administered heparin influences skin microcirculation (capillary venous oxygen saturation SO2, blood filling of microvessels, blood flow, and velocity) in healthy subjects. METHODS: Skin perfusion parameters on the forearm were measured with the O2C device in a double-blinded, controlled, and randomized study with 50 healthy subjects after administration of heparin ointment in three different concentrations and a control ointment (dexpanthenol). RESULTS: Topically administrated heparin slightly increased SO2 (max. 187 ± 285 SD or standard deviation % vs. 145 ± 129 SD %), flow (max. 264 ± 427 SD % vs. 151.74 ± 111 SD %), and velocity (max. 153 ± 149 SD % vs. 122 ± 56 SD %) after an incubation time of 60 minutes in comparison to control. No statistically significant difference could be detected regarding heparin concentration. CONCLUSION: As a first important step in possible future implementing of heparin as a topical administration in flap surgery, our data-although not statistically significant-indicate that heparin can improve microcirculation (SO2, flow) in healthy subjects. Nevertheless, further research in subjects with impaired microcirculation is necessary.

Does Phototherapy Promote Wound Healing? Limitations of Blue Light Irradiation.

INTRODUCTION: Phototherapy is gaining increased attention in the research and treatment of various diseases. In particular, the use of blue light seems to bear promise, owing to its antimicrobial and immune-modulating properties; however, research focused on the effects of blue light on keratinocytes and reepithelization is rare. In addition, few studies to date have evaluated devices that are used in daily hospital routine. OBJECTIVE: This study investigated the effects of phototherapy on keratinocytes with 2 established devices in vitro. MATERIALS AND METHODS: Human adult low calcium high temperature keratinocytes were irradiated with 2 different devices, and the effects on scratch wound closure, proliferation, cell viability, and cytokine expression were evaluated. RESULTS: Blue light irradiation reduced reepithelization at high doses in a scratch wound healing model (wound closure on day 1: control group, 25.57 percentage points [PP] ± 2.36 standard deviation vs Device A for 10 minutes, 1.33 PP ± 1.01) and mitochondrial activity measured with resazurin conversion (Device A for 10 minutes, 33.28% ± 12.34). Irradiated cells demonstrated a lower ratio of proliferating cell nuclear antigen-positive cells and, as a result, lower proliferation. CONCLUSIONS: Blue light reduces keratinocyte proliferation and migration at high doses and therefore could negatively affect wound healing. Available irradiation devices for possible use in wound therapy should be critically scrutinized and evaluated with in vitro methods prior to clinical use.

Microvascular tissue transfer after the resection of soft tissue sarcomas.

BACKGROUND: Microvascular tissue transfer enables the oncological resection of soft tissue sarcomas of the extremities and the trunk by covering the resulting tissue defects that are often extensive. This study was performed to investigate the long-term survival and functional outcome of patients treated with free flaps after sarcoma resection. METHODS: A total of 78 sarcoma patients received microvascular tissue transfer in our institution between March 2003 and January 2013. In a retrospective analysis, we investigated data such as tumor characteristics as well as survival time and disease-free survival. In a prospective analysis, we assessed the functional outcome and the health-associated quality of life with the TESS and SF-36 questionnaire, respectively. RESULTS: Seventy patients qualified for disease-free survival after tumor resection, 41 patients remained disease free for over 5 years. Forty-five patients reached a survival time of more than 5 years. The functional results experienced by our patients were good with a mean score of 82.6% in the TESS. The physical health-related quality was lower than in the German norm sample and patients suffering from chronical illnesses or cancer, whereas the mental health was only slightly lower than in the norm sample and higher than in the groups with chronic illnesses or cancer (SF-36). CONCLUSION: Microvascular tissue transfer enables tumor resection and limb salvage through the coverage of the resulting defects without impairing patients' prognosis. The long survival times after tumor resection emphasizes the need for good functional results as well as quality of life.

Evaluation of a cross-linked versus non-cross-linked collagen matrix in full-thickness skin defects.

Autologous skin transplantation is the gold standard for treatment of full-thickness skin defects such as deep burn injuries, but has the disadvantages of limited donor sites and donor site morbidities. Alternative skin replacement products, such as xenografts and allografts, are not a permanent solution. Numerous manufactured skin substitutes already show promising approaches, but have limited efficacy. Therefore, wound dressings adaptable to the physiology of wound healing are still needed. In a randomized controlled in vivo study, a newly designed biocompatible collagen nonwoven matrix was compared to the Integra® bilayer dermal substitute and untreated controls in 48 full-thickness skin defects in a swine model. The take of all templates was complete, and all the tissue-engineered products accelerated dermal wound healing compared to the untreated controls, as identified by planimetric measurements. The higher collagen dose treatments and Integra®-covered wounds developed the thickest, cell-rich neoepidermal tissue in histological examination. The innovative biocompatible collagen matrix is flexibly applicable and modifiable, and offers potential as a carrier membrane for therapeutic supplemental products such as growth factors to further develop effective wound dressings.

Complement activation at the interface of wound dressings and blood does not influence keratinocyte migration/proliferation in vitro.

Recently, we reported that some wound dressings caused complement activation at the interface of wound dressing and blood. Since complement activation is associated with impaired wound healing, we investigated whether this activation of the complement cascade at the interface of wound dressings and blood does impair reepithelialization in a scratch wound healing assay. Although some samples showed higher levels of the complement activation marker SC5b-9 in our study, reepithelialization of the samples did not significantly differ from the control group. Further studies have to clarify if complement activation at the interface of wound dressings and blood plays a relevant role in the healing process especially in long-time experiments.

The acute impact of local cooling versus local heating on human skin microcirculation using laser Doppler flowmetry and tissue spectrophotometry.

INTRODUCTION: Knowledge of thermally induced skin injury has increased, but its pathophysiology remains unclear. Although it is assumed that local cooling may protect tissue, little is known about the impact of local heating on human skin. This study aimed to evaluate acute skin perfusion dynamics following thermal stimuli in healthy human volunteers. MATERIAL AND METHODS: In 54 subjects, a TSA-II-NeuroSensory Analyzer was used to induce local hypothermia (15 °C and 5 °C) and local hyperthermia (40 °C and 45 °C) at the palmar forearm of healthy volunteers. Changes in tissue microcirculation were assessed using an O2C device before and after each temperature change. RESULTS: Blood flow and velocity values showed a continuous decrease with decreasing skin temperature, whereas haemoglobin oxygen saturation (SO2) showed a continuous increase in superficial (2 mm) and deep layers (8 mm). With increasing skin temperature, flow, SO2 and velocity increased in the superficial and deep layers. The relative amount of haemoglobin (rHB) did not show a continuous alteration. DISCUSSION: Local cooling may protect damaged tissue due to increased SO2 (lower oxygen consumption). However, reduced blood flow and velocity in response to local cooling limit nutrient requirements and the transport of metabolites. Despite higher oxygen consumption of tissue at higher temperatures, both blood flow and SO2 increase. Thus, we hypothesize that not only hypothermia but also hyperthermia may provide tissue protection.

A quantitative study of hydration level of the skin surface and erythema on conventional and microclimate management capable mattresses and hospital beds.

BACKGROUND: In addition to pressure itself, microclimate factors are gaining more attention in the understanding of the development of pressure ulcers. While there are already various products to reduce pressure on sore-prone areas to prevent pressure ulcers, there are only a few mattresses/hospital beds that actively influence skin microclimate. In this study, we investigated if microclimate management capable mattresses/hospital beds can influence skin hydration and skin redness/erythema. METHODS: We included 25 healthy subjects in our study. Measurements were made using Courage & Khazaka Multi Probe Adapter MPA with Corneometer CM825 and Mexameter MX18 to determine skin hydration of the stratum corneum and skin redness/erythema before and after the subjects were lying in conventional (Viskolastic® Plus, Wulff Med Tec GmbH, Fedderingen, Germany and Duo™ 2 mattress, Hill-Rom GmbH Essen, Germany) or microclimate management capable mattresses/hospital beds (ClinActiv + MCM™ and PEARLS AFT, Hill-Rom GmbH Essen, Germany). RESULTS: While there was no difference in skin redness/erythema on the different mattresses/hospital beds, skin hydration of the stratum corneum decreased significantly in an air fluidized bed compared to baseline values and values measured on standard mattress/Viskolastic® Plus. CONCLUSION: Air-fluidized therapy reduces skin hydration and therefore could contribute to prevent moisture associated ulcers. Changes in skin hydration as one important factor of skin microclimate can be detected after a short time of incubation and even before an erythema appears.

A quantitative study of transepidermal water loss (TEWL) on conventional and microclimate management capable mattresses and hospital beds.

BACKGROUND: Transepidermal water loss (TEWL) is regarded as one of the most important parameters characterizing skin barrier integrity and has found to be higher in impaired skin barrier function. Reduced or low TEWL instead indicates skin barrier integrity or improvement. We evaluated if different mattresses/hospital beds can influence this skin barrier function by measuring TEWL before and after subjects lying in conventional and microclimate management capable mattresses/hospital beds. METHODS: We included 25 healthy subjects in our study. Measurements were made using Courage & Khazaka Multi Probe Adapter MPA with Tewameter TM300 to determine TEWL before and after the subjects were lying in conventional (Viskolastic® Plus, Wulff Med Tec GmbH, Fedderingen, Germany and Duo™ 2 mattress, Hill-Rom GmbH Essen, Germany) or microclimate management capable mattresses/hospital beds (ClinActiv + MCM™ and PEARLS AFT, Hill-Rom GmbH Essen, Germany). RESULTS: While there was no statistically significant difference in standard mattresses/hospital beds (22.19 ±â€¯12.99 and 19.80 ±â€¯11.48 g/hm2), the decrease of TEWL was statistically significant in both microclimate management capable mattresses/hospital beds we investigated (16.89 ±â€¯8.586 g/hm2 and 17.41 ±â€¯7.203 g/hm2) compared to baseline values (35.85 ±â€¯24.51 g/hm2). CONCLUSION: As higher TEWL announces impaired skin barrier function these findings indicate that the choice of the mattress/hospital bed is important for skin barrier function and microclimate management systems improve skin barrier function of the skin.

Gelatin-Collagen Nonwoven Scaffold Provides an Alternative to Suprathel for Treatment of Superficial Skin Defects.

OBJECTIVE: To evaluate the effect of a new biologic gelatin-collagen nonwoven scaffold compared with a more common synthetic wound dressing on the healing of superficial wounds. METHODS: Three superficial wounds with a depth of 0.5 mm and a length of 2.4 cm were created on the flanks of six minipigs using a skin dermatome. One wound on each pig was treated with the new nonwoven scaffold, one with the more common synthetic wound dressing, and one functioned as an untreated control wound. All three wounds were then covered with a semipermeable, sterile, transparent film. RESULTS: After 7 days, complete wound closure of all wounds could be detected; epidermal thickness and the number of epidermal cells of all treated wounds were significantly increased compared with the control wounds. The nonwoven dressing showed slightly better results compared with the more common dressing. CONCLUSIONS: The nonwoven scaffold is an interesting and competitive material for promoting epidermal wound healing. Because it is a biologic dressing, it degenerates completely and does not have to be removed from the wound. Further research should be conducted to compare this new dressing with other currently available wound treatments.

Elastic Wrapping of Lower Extremity Free Flaps during Dangling Improves Microcirculation and Reduces Pain as well as Edema.

BACKGROUND: Free tissue transfer has become a common and safe reconstructive procedure. However, total or partial flap losses remain a looming threat, especially for lower extremity free flaps due to the gravitational challenge associated with dependency. Thus, the majority of microsurgical centers apply some kind of structured flap training. However, due to the lack of evidence, these differ greatly, for example, in the application of an elastic wrapping during dangling. Therefore, the aim of this study was to assess the impact of an elastic wrapping on free flap microcirculation, edema, and pain during dangling. METHODS: Standardized dangling was performed from postoperative day (POD) 6 to 9 in 30 patients with microvascular reconstruction of the lower extremity. The first dangling per day was performed without elastic wrapping, followed by another session with 30 mm Hg of elastic wrapping. Tissue oxygen saturation (StO2), regional hemoglobin content (rHb), and blood flow (BF) were continuously measured in the free flap; the circumference of the flap as well as pain was assessed. RESULTS: During wrapped dangling, BF as well as StO2 was significantly increased, while rHb was significantly lower on all PODs. Wrapped dangling was rated significantly more comfortable and the girth of the free flaps was significantly less after wrapped dependency when compared with unwrapped dangling. CONCLUSION: Dangling with an elastic wrapping with 30 mm Hg pressure improved flap microcirculation and reduced pain and edema formation.

Hemocompatibility of different burn wound dressings.

A variety of wound dressing are available for burns. Furthermore, although their impacts on wound healing have been studied sufficiently, their effects on blood remain unclear. Meanwhile, this aspect is extremely important, since blood interacts with the wound dressing, especially in extensive burn injuries. Therefore, the aim of this study is to evaluate the hemocompatibility and immunogenicity of different burn wound dressings. Accordingly, human whole blood (n = 5) was anticoagulated with heparin, treated with different wound dressings and incubated at 37°C for 30 minutes. Different parameters for coagulation and hemocompatibility were evaluated before and after incubation. Consequently, Jelonet, Xenoderm, and Matriderm showed higher TAT-III concentrations, Jelonet, Xenoderm, EZ Derm, and Matriderm were higher ß-thromboglobulin; EZ Derm and Burntec showed higher SC5b-9 concentrations after incubation with whole blood. Our ex vivo study provided initial insights into the hemocompatibility and immunogenicity of different burn wound dressings. Moreover, Xenografts (Xenoderm and EZ Derm), Jelonet and Matriderm showed a hemostyptic effect, while EZ Derm and Burntec activated the complement system. Therefore, further studies must be conducted to analyze the possible effects in vivo.

[SL fusion - no alternative for the treatment of chronic scapholunate dissociation]. / SL-Fusion ­ keine Alternative zur Behandlung der chronischen skapholunären Dissoziation.

INDRODUCTION: The treatment of chronic scapholunate dissociation (SLD) is currently uneven and still presents a major challenge. Both, the primary ligament suture and frequently applied ligament reconstruction techniques cannot provide a permanent stable connection between the scaphoid and lunate. For this reason, the present study evaluates the value of a bony compound as a treatment option for the treatment of chronic SLD. PURPOSE: To evaluate the radiological and clinical outcome of scapholunate fusion for chronic SLD. PATIENTS AND METHODS: Ten patients with a scapholunate fusion with corticocancellous iliac bone graft interposition and Herbert screw fixation for symptomatic chronic SLD were retrospectively evaluated in terms of clinical and radiological findings after a mean of 7.6 years. The examination included range of motion, grip strength, pain, DASH, Krimmer and Modified Mayo Wrist Score (MMWS), and a radiological examination. RESULTS: Primary bone healing was achieved in 4 out of 10 patients. In 2 patients, bone healing of the scapholunate fusion was achieved after revision surgery, in one patient by including the capitate bone in the fusion. Two patients developed fibrous nonunion. In 2 patients, the SLD persisted, requiring a four-corner fusion and wrist denervation, respectively. In all patients, degenerative changes were seen in the radiocarpal joint at follow-up. In spite of the radiological results, the clinical results ranged from fair to good. Seven patients were pain-free at rest. The average MMWS Score was 72 (40-95), the Krimmer Score 78 (55-100), and the DASH Score 17 (0-60). CONCLUSION: Although the clinical results were fair to good, scapholunate fusion cannot be recommended for the treatment of chronic SLD due to a primary failure rate of 60 % regarding bone healing and a 40 % rate of revision surgery.

Quantitative Analysis of Heel Skin Microcirculation Using Laser Doppler Flowmetry and Tissue Spectrophotometry.

OBJECTIVE: To examine perfusion changes in the heel skin of individuals with and without diabetes mellitus to understand how skin is pathologically affected by diabetes mellitus. METHODS: This case-control study was conducted at an academic hospital in Tuebingen, Germany. A total of 30 subjects were enrolled in the study: 15 with known type 2 diabetes mellitus and 15 without. Each subject was asked to lie in a supine position on a hard lateral transfer mat for 10 minutes. MAIN OUTCOME MEASURES: Heel perfusion was quantitatively assessed directly after relief of pressure and after 3 and 6 minutes after relief of pressure using laser Doppler flowmetry and tissue spectrophotometry. MAIN RESULTS: Directly after relief of pressure, blood flow increased in the superficial skin layers (2 mm below the surface of the skin) in both groups. However, in deep skin layers (8 mm below the surface of the skin), blood flow increased in patients with diabetes mellitus and decreased in healthy patients. Oxygen saturation (SO2) was higher in healthy subjects directly after pressure relief. CONCLUSIONS: The increase in blood flow in superficial skin layers indicates reactive hyperemia after exposure in both groups. The prolonged hyperemia in deep skin layers in patients with diabetes indicates increased tissue vulnerability. Despite the increase in blood flow in deep skin layers, the SO2 and thus supply of tissue in patients with diabetes were reduced.

Comparison of spontaneous sensory recovery of noninnervated anteromedial thigh flap, latissimus dorsi flap, and gracilis muscle flap in lower extremity reconstruction: A prospective comparative study.

BACKGROUND: We evaluated the time course and differences in the sensory recovery of three commonly used free flaps for lower extremity reconstruction. Furthermore, the sensory recovery of skin-grafted muscle and skin paddle in latissimus dorsi flaps (LDMF) were differentiated. METHODS: In a prospective study, 26 patients who had undergone free flap lower extremity reconstruction were enrolled. Among them, 9 received LDMF, 9 received gracilis muscle flaps (GMF), and 8 received anterior lateral thigh flaps (ALTF). The sensory recovery was investigated by using the Semmes-Weinstein test (SWT) at 6 and 12 months after the surgery. RESULTS: All flaps recorded spontaneous sensory recovery. The GMF showed the smallest anesthetic area after 12 months as compared with the ALTF and LDMF (1 ± 3% vs. 18 ± 39% (p < .05) vs. 35 ± 35% (p < .05), respectively). Qualitatively, ALTF exhibited the best sensory recovery with the lowest SWT values (ALTF 4.57 ± 1.12 vs. GMF 5.01 ± 0.81 8 [p < .05], vs. LDMF 5.84 ± 0.52 [p < .05]). The sensory recovery of skin-grafted muscle was superior to that of the skin paddle in the LDMF (anesthetic area 29 ± 36% vs. 54 ± 33% [p < .05], SWT 5.85 ± 0.60 vs. 6.30 ± 0.18 [p < .05], respectively). CONCLUSION: All flaps displayed spontaneous sensory recovery potential over the investigation period, which appeared to be influenced by the flap type and size. The LDMF skin paddle showed lower potential for sensory recovery as compared with the skin-grafted muscle area of the same flap. The GMF demonstrated a near-complete sensory recovery after 12 months.