A new approach to microneurovascular TRAM-flap breast reconstruction – a pilot study

Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy

“…The finding of improved breast sensation postoperatively with innervation has also been demonstrated in TRAM flaps, including one randomized controlled trial . While studies compared results with and without nerve grafts, only one utilized a nerve conduit . However, there is significant variability among the studies in regards to surgical protocols, nerves and grafts utilized and postoperative sensory testing, making comparison between studies difficult …”

“…[28][29][30][31][32][33] While studies compared results with and without nerve grafts, only one utilized a nerve conduit. [25][26][27][28][30][31][32][33][34][35][36][37][38] However, there is significant variability among the studies in regards to surgical protocols, nerves and grafts utilized and postoperative sensory testing, making comparison between studies difficult. 18,19…”

Improved sensory recovery with a novel dual neurorrhaphy technique for breast reconstruction with free muscle sparing TRAM flap technique

“…It has previously been shown that the nerves supplying cutaneous sensation to the abdominal wall follow the course of both the medial and lateral vascular perforators, and that sensory nerves are connected to each other via multiple branches, in a net‐like manner, which means that a single nerve may provide sensation to the entire abdominal flap . In our earlier pilot work, we demonstrated that single neurorrhaphy on the vascular pedicle side sufficed to give a neuro ms‐TRAM flap on average almost half of the sensitivity of a healthy breast and 60% improved sensitivity compared to a ms‐TRAM flap without neurorrhaphy . Furthermore, neurorrhaphy does not impair the skin sensitivity of the abdominal flap donor site post‐operatively, not even after dual neurorrhaphy …”

“…On the lateral thoracic side, a neurorrhaphy was performed between the donor 10th–12th intercostal nerves of the flap and the recipient costobrachial or thoracodorsal nerves, as well as branches of the intercostal 4th–5th nerves within the axillary region as described in our pilot work (Fig. ) …”

“…Previously, we harvested a recipient nerve from the side of the thoracodorsal vessel pedicle in the axillary area during dissection for single neurorrhaphy . In other studies, however, the medial 4th intercostal nerve has most often been used as the recipient nerve at the level of internal mammary vessels because the nipple‐areola complex is consistently innervated by its anterior and lateral cutaneous branches …”