Patient-reported outcomes after free muscle flap coverage for therapy-resistant neuropathic pain from the ulnar nerve

TL;DR

A surgical procedure combining neurolysis and muscle flap coverage reduces long-term pain in patients with resistant ulnar nerve neuropathy.

Contribution

Demonstrates the long-term effectiveness of free gracilis muscle flap coverage for resistant ulnar nerve pain.

Findings

Median pain score decreased significantly 8 months post-surgery and remained lower at 3 years.

Health-related quality-of-life scores were still below normative data despite pain reduction.

The procedure shows promise for treating therapy-resistant ulnar nerve neuropathic pain.

Abstract

Extensive microsurgical neurolysis followed by free gracilis muscle flap coverage can be performed as a last resort for patients with persistent neuropathic pain of the ulnar nerve. All patients who had this surgery between 2015 and 2021 were identified. Data were collected from the medical records of 21 patients and patient-reported outcomes were collected from 18 patients, with a minimum follow-up of 12 months. The median visual analogue pain score decreased significantly 8 months postoperatively from 8.0 to 6.0 and stabilized to 5.4 at the 3-year follow-up. Health-related quality-of-life scores remained diminished compared to normative data. In the treatment of therapy-resistant neuropathic pain of the ulnar nerve, extensive neurolysis with a subsequent free gracilis muscle flap coverage shows a promising reduction of pain that persists at long-term follow-up.

Level of evidence: IV

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