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

Abstract

Dual neurorrhaphy improved the sensory recovery of the reconstructed breast, and may therefore be recommended for clinical practice. © 2014 Wiley Periodicals, Inc. Microsurgery 37:21-28, 2017.

Sensory restoration of breast reconstruction – The search for the ideal approach continues

“…The initial search retrieved a total of 416 unique articles, of which 22 articles underwent full‐text review (Figure ) . Twenty articles focused on clinical outcomes of non‐neurotized and neurotized deep inferior epigastric perforator (DIEP) and transverse rectus abdominis musculocutaneous (TRAM) flaps . Two studies were excluded because they evaluated flaps other than abdominal flaps .…”

“…Between 1995 and 2016, a total of 24 clinical studies investigated sensory return following autologous breast reconstruction with abdominal flaps . Eight studies evaluated sensation following DIEP flap transfer and 17 studies following TRAM reconstruction (Tables and ). The majority of studies were retrospective cohort studies or case series.…”

“…A total of 78 neurotized and 141 non‐neurotized DIEP flaps in a total of 194 patients (mean age [range] 44‐56 years) have been reported in the literature . Additionally, 183 neurotized and 272 non‐neurotized TRAM flaps (both pedicled and free) in a total of 426 patients (mean age [range] 45–63 years) have been reported …”

“…Direct nerve coaptation of the donor and recipient nerve was most commonly performed in an end‐to‐end manner, but occasionally in an end‐to‐side manner . Spiegel et al (2013) used a 40‐mm nerve conduit that bridged the gap between donor and recipient nerves.…”

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

“…25 The finding of improved breast sensation postoperatively with innervation has also been demonstrated in TRAM flaps, including one randomized controlled trial. [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.…”