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Free Flap Neurotization: Indications, Techniques, and Future Directions
Christopher M Frost1, Grant Kleiber2, Sami Tuffaha1
1From the Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital.
Plastic and Reconstructive Surgery
|March 25, 2026
Summary
Free flap neurotization enhances reconstruction by restoring sensation, improving protective function and patient self-perception. This technique is increasingly used in autologous free tissue transfer for better functional outcomes.
Area of Science:
- Microsurgery
- Reconstructive Surgery
- Neurosensory Research
Background:
- Autologous free tissue transfer is crucial for reconstructive surgery.
- Maximizing functional outcomes, including sensation, is a growing focus.
- Neurotized free flaps offer improved sensibility in reconstructions.
Purpose of the Study:
- To outline operative techniques for harvesting sensory-innervated free flaps.
- To detail donor nerve options for various recipient sites.
- To discuss clinical outcomes and considerations of free flap neurotization.
Main Methods:
- Review of current surgical techniques for free flap harvesting.
- Analysis of donor nerve selection for neurotization.
- Discussion of clinical data and advantages of neurotized flaps.
Main Results:
- Multiple free flap types can be harvested with sensory innervation.
- Various donor nerves are available for common recipient locations.
- Neurotized flaps provide protective sensation and enhance self-perception.
Conclusions:
- Free flap neurotization is an advancing trend in reconstructive surgery.
- Restoring sensation improves both protective function and psychological well-being.
- This technique maximizes the functional benefits of free flap reconstruction.
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