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Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report

As the transgender population increases, gender-affirming surgeries are being performed at unprecedented rates. Despite this increase, complications and long-term outcomes of gender-affirming interventions are largely understudied. We present a transgender patient who underwent radial forearm free f...

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Autores principales: Jolly, Divya, Chrisos, Haley A., Kaufman-Goldberg, Tal, Ganor, Oren, Taghinia, Amir H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489613/
https://www.ncbi.nlm.nih.gov/pubmed/32983782
http://dx.doi.org/10.1097/GOX.0000000000003027
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author Jolly, Divya
Chrisos, Haley A.
Kaufman-Goldberg, Tal
Ganor, Oren
Taghinia, Amir H.
author_facet Jolly, Divya
Chrisos, Haley A.
Kaufman-Goldberg, Tal
Ganor, Oren
Taghinia, Amir H.
author_sort Jolly, Divya
collection PubMed
description As the transgender population increases, gender-affirming surgeries are being performed at unprecedented rates. Despite this increase, complications and long-term outcomes of gender-affirming interventions are largely understudied. We present a transgender patient who underwent radial forearm free flap (RFFF) phalloplasty as part of gender affirmation. Immediately following surgery, the patient reported paresthesia in the donor arm in the median nerve distribution followed by a neuropathic pain after 1 week. The patient complained of shooting and burning pain and reported a loss of sensation and function at the donor site. Electromyography and magnetic resonance imaging results indicated median nerve damage several inches above the donor site. The symptoms persisted for several months before spontaneously resolving. The spontaneous resolution and location of injury suggest that nerve damage occurred as a result of pneumatic tourniquet application despite adherence to all clinical guidelines for a safe tourniquet application of the same. This is the first reported case of neuropathic pain following RFFF phalloplasty occurring at the donor site. Given the large donor area and the long time of tourniquet application, surgeons offering RFFF phalloplasty must be aware of and actively counsel patients seeking this procedure about the potential for nerve-related damages before surgery.
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spelling pubmed-74896132020-09-24 Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report Jolly, Divya Chrisos, Haley A. Kaufman-Goldberg, Tal Ganor, Oren Taghinia, Amir H. Plast Reconstr Surg Glob Open Reconstructive As the transgender population increases, gender-affirming surgeries are being performed at unprecedented rates. Despite this increase, complications and long-term outcomes of gender-affirming interventions are largely understudied. We present a transgender patient who underwent radial forearm free flap (RFFF) phalloplasty as part of gender affirmation. Immediately following surgery, the patient reported paresthesia in the donor arm in the median nerve distribution followed by a neuropathic pain after 1 week. The patient complained of shooting and burning pain and reported a loss of sensation and function at the donor site. Electromyography and magnetic resonance imaging results indicated median nerve damage several inches above the donor site. The symptoms persisted for several months before spontaneously resolving. The spontaneous resolution and location of injury suggest that nerve damage occurred as a result of pneumatic tourniquet application despite adherence to all clinical guidelines for a safe tourniquet application of the same. This is the first reported case of neuropathic pain following RFFF phalloplasty occurring at the donor site. Given the large donor area and the long time of tourniquet application, surgeons offering RFFF phalloplasty must be aware of and actively counsel patients seeking this procedure about the potential for nerve-related damages before surgery. Lippincott Williams & Wilkins 2020-08-14 /pmc/articles/PMC7489613/ /pubmed/32983782 http://dx.doi.org/10.1097/GOX.0000000000003027 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Reconstructive
Jolly, Divya
Chrisos, Haley A.
Kaufman-Goldberg, Tal
Ganor, Oren
Taghinia, Amir H.
Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report
title Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report
title_full Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report
title_fullStr Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report
title_full_unstemmed Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report
title_short Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report
title_sort median nerve neuropathy following radial forearm free flap phalloplasty: a case report
topic Reconstructive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489613/
https://www.ncbi.nlm.nih.gov/pubmed/32983782
http://dx.doi.org/10.1097/GOX.0000000000003027
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