Back to 2024 Abstracts
Fat versus Muscle Flap - Comparison of Techniques to Protect the Greater Occipital Nerve After Decompression
Katya Remy
*1, Merel H. Hazewinkel
2, Connor Mullen
3, William G. Austen
1, Robert R. Hagan
3, Lisa Gfrerer
21Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA; 2Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY; 3Neuropax Clinic, St Louis, MO
IntroductionGreater Occipital Nerve (GON) neurolysis is typically followed by elevation of a subcutaneous fat flap that is wrapped around the nerve for cushioning. However, this technique places the nerve in a superficial position with the risk of recurrent pain. More recent techniques bury the nerve under the trapezius and semispinalis muscle to position the nerve deep in the soft tissues. This article discusses and compares the outcomes of both techniques.
MethodsWe retrospectively identified patients who underwent screening for occipital nerve decompression surgery between 2010-2023 at 3 centers. All patients that had primary GON decompression surgery were included. Pain frequency (days/month), intensity (0-10) and duration (hours) were prospectively collected preoperatively and at 3 and 12 months follow-up. Chart reviews collected data on flap type, complications and reoperations. Patients who underwent GON decompression with a fat flap were compared to those who underwent a muscle flap.
Results 317 (19%) patients underwent GON decompression. A fat flap was used in 203 (64%) and a muscle flap in 114 (36%) patients. Postoperative complications included wound infections (2.2%), seroma (1.6%) and wound dehiscence (1.0%) and were similar between groups (p=0.674). The reoperation rate was significantly higher in the fat flap group as compared to the muscle flap group (n=24, 12% vs n=5, 4.4%; p=0.045). All patients had a reoperation due to recurrent pain. After the last intervention, the median pain days per month decreased by 18 days (5-27), duration reduced by 12 hours (2-24), and pain intensity decreased by 5 points (3-7). When comparing postoperative pain characteristics between the fat flap and the muscle flap group after the last intervention, outcomes were similar between both groups (p>0.05). The mean follow-up was 9 (±4.1) months.
ConclusionBoth fat and muscle flap techniques for GON decompression can effectively reduced pain. However, the muscle flap approach resulted in a lower reoperation rate, potentially providing better long-term pain relief.
Back to 2024 Abstracts
