Radial forearm free flap (RFFF) reconstruction is commonly used for head and neck defects but is associated with donor-site morbidity, including neuropathic pain and sensory disturbance. This randomized controlled pilot study evaluates whether placement of a soft tissue matrix over the superficial radial nerve at the donor site reduces neuropathic pain and improves sensory outcomes compared to standard closure alone.
Radial forearm free flap (RFFF) harvest is associated with significant donor-site morbidity, including neuropathic pain, hypoesthesia, and functional impairment related to superficial radial nerve irritation and postoperative scar formation. Current donor-site management focuses on wound closure and healing but does not directly address nerve protection. Avive+ Soft Tissue Matrix is a human-derived biologic material designed for soft tissue reinforcement and protection. Its use as a barrier over surgically manipulated nerves is biologically plausible but has not been studied in this clinical context. This study is a prospective, randomized controlled pilot trial designed to evaluate the feasibility, safety, and preliminary efficacy of Avive+ placement over the superficial radial nerve during RFFF harvest. Subjects will be randomized to standard closure versus Avive+ placement plus standard closure. Outcomes will focus on neuropathic pain, sensory function, and wound complications.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
80
* Standard RFFF harvest * Split-thickness skin graft (STSG) donor-site closure
* Standard RFFF harvest * Placement of Avive+ Soft Tissue Matrix over the superficial radial nerve * STSG donor-site closure
University of Alabama at Birmingham
Birmingham, Alabama, United States
Clinically Significant Neuropathic Pain at 6 Months - DN4 score
A DN4 questionnaire score of 4 or higher out of 10 indicates a high probability of neuropathic pain. This validated tool, which can be viewed in this DN4 Questionnaire consists of seven patient-interview questions and three clinician-examination items, with a total score distinguishing neuropathic from non-neuropathic pain. A score greater than or equal to 4 is considered positive for neuropathic pain
Time frame: 6 months
Clinically Significant Neuropathic Pain at 6 Months - Numeric Rating Scale
Numeric Rating Scale (NRS) is used to measure pain, where 0 is "no pain" and 10 is "worst pain imaginable"
Time frame: 6 months
Average Pain Severity
Numeric Rating Scale (NRS): Commonly used in healthcare to measure pain, where 0 is "no pain" and 10 is "worst pain imaginable"
Time frame: 1, 3, 6, and 12 months
Average Sensory Function with Semmes-Weinstein monofilament testing
The Semmes-Weinstein monofilament test is a quick, non-invasive, and objective clinical exam used to evaluate nerve function by measuring skin sensitivity to light touch and pressure.
Time frame: 1, 3, 6, and 12 months
Average Sensory Function with Static 2-point discrimination
Static 2-point discrimination (2PD) is a clinical test measuring the minimum distance at which a patient can perceive two simultaneous touch stimuli as distinct, rather than one, using a device like an aesthesiometer or disk-criminator.
Time frame: 1, 3, 6, and 12 months
Percentage of Skin Graft Loss
Measured by percentage of 0-100% total graft loss.
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Time frame: up to 3 months
Number of Participants that develop Infection
Measured by presence of cellulitis/purulence requiring antibiotics and/or surgical debridement with antibiotics.
Time frame: Up to 3 months
Number of participants with Tendon Exposure
Measured by number of participants with visual appearance of tendon exposure.
Time frame: up to 3 months
Change in QuickDASH score
The QuickDASH is an 11-item questionnaire assessing upper limb musculoskeletal disability, scoring from 0 (no disability) to 100 (most severe).
Time frame: 3, 6, and 12 months