Spontaneous Reinnervation of Deep Inferior Epigastric Perforator Flaps after Delayed Breast Reconstruction

Stromps, Jan-Philipp; Bozkurt, Ahmet; Grieb, Gerrit; Kim, Bong-Sung; Wiezik, Martyna; Pallua, Norbert

doi:10.1055/s-0035-1564062

Cited by 18 publications

(22 citation statements)

References 21 publications

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“…Large-fiber function improves with time in accordance with other studies tracking sensory recovery for at least 12 months or more postoperatively. 2,6,8,9,11,12,18,21,22 Furthermore, insufficiently recovered CDT and MPT as shown in our study indicate impairment of thinly myelinated Aδ-fiber function, whereas WDT and, thus, C-fiber function recovered within the normal range. Temperature discrimination, as measured by the TSL, however, was within the normal range in the periphery and recovered over time in the center, indicating only partial loss of Aδ-fiber function.…”

Section: Discussionsupporting

confidence: 57%

“…In accordance with our study, few authors report partly recovered temperature perception but do not report the quality of recovery. 6,7,16–18,23,26…”

Section: Discussionmentioning

confidence: 99%

“…19,20 Moreover, satisfactory partial sensory reinnervation has also been described in nonneurotized free flaps in breast reconstruction. 6–9,11,12,15,22–26…”

mentioning

confidence: 99%

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Standardized Quantitative Sensory Testing to assess insufficient recovery of touch discrimination in free flap surgery in extremity reconstruction

Huber

Scharberth

Maier

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: With major advances in microsurgical techniques, free tissue transfer has become a widely adopted approach to treat complex soft-tissue defects. However, sensory recovery is poor, leaving the anesthetic skin prone to injuries. Methods: Twenty-eight patients with 22 anterior lateral thigh flaps and six latissimus dorsi flaps on their extremities participated in the study. Quantitative sensory testing and two-point discrimination was performed in three test areas and one control on the contralateral unaffected extremity. Physical disability, mental health, quality of life, and characteristics of pain were assessed by the painDetect, Disabilities of the Arm, Shoulder, and Hand, Lower Extremity Functional Scale, and 12-Item Short Form questionnaires, respectively. Results: Somatosensory profiles of all flaps were characterized by an overall loss of nerve function. Small-fiber function was mostly recovered, whereas large-fiber function, and thus touch discrimination, was severely impaired. Mechanical detection thresholds improved over time and from center to the periphery. Reported pain was mild to moderate and correlated with decreased physical function. Conclusions: Standardized quantitative sensory testing provides a useful tool kit to assess the sensory regeneration after surgical treatment of soft-tissue defects. After free tissue transfer, small-fiber function recovers with nerve ingrowth in a centripetal direction from the flap margins to the center, likely by way of collateral axonal sprouting from the undamaged nerves surrounding the flap. Myelinated fibers recover slowly and inefficiently. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Section: Discussionsupporting

confidence: 57%

“…In accordance with our study, few authors report partly recovered temperature perception but do not report the quality of recovery. 6,7,16–18,23,26…”

Section: Discussionmentioning

confidence: 99%

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Standardized Quantitative Sensory Testing to assess insufficient recovery of touch discrimination in free flap surgery in extremity reconstruction

Huber

Scharberth

Maier

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…3,7,14,25,26 To optimize patient care and success rate of sensory return, it is essential to evaluate each patient individually, based on their medical history, oncologic therapy, type of mastectomy, age, weight, nicotine use, diabetes, and time between mastectomy and reconstructive surgery. 27 All of these parameters can influence nerve regeneration and must be considered to manage patient and surgeon expectations. For instance, patients with previous radiation and reconstruction attempts should be counseled about technical difficulties associated with neurotized reconstruction, as these factors may preclude the intercostal nerves from being used.…”

Section: Discussionmentioning

confidence: 99%

Sensory restoration in abdominally-based free flap for breast reconstruction using nerve allograft

Djohan

Scomação

Duraes

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Neurotization in breast reconstruction can be performed with the aid of nerve grafts and conduits to decrease the tedious dissection and overcome size mismatch. However, there has yet to be a formal analysis of this approach. The goal of this study was to evaluate sensory recovery after neurotized abdominally based free flaps for breast reconstruction using the authors’ novel technique and analyze factors that could affect sensory recovery. Methods: A novel technique using processed nerve allograft in combination with a nerve conduit was used. Dynamic and static sensation recovery tests were performed in patients who underwent neurotized or nonneurotized abdominally based free flap reconstructions. Demographics, surgical details, and complications were analyzed. Statistical analyses were performed using chi-square and Mann-Whitney tests. Results: Fifty patients (78 breasts) were analyzed: 60 breasts with neurotized reconstruction and 18 breasts without. For patients with more than 12 months of follow-up, the neurotized cohort demonstrated improved dynamic tests compared to the nonneurotized cohort (38 ± 21.69 versus 56.17 ± 20.8, respectively; P = 0.014). Factors associated with decreased sensory return in patients who underwent neurotized reconstruction were diabetes, higher body mass index, skin-sparing mastectomy, higher American Society of Anesthesiologists class, history of radiation therapy, or history of hormonal therapy. Conclusions: This is the first study to report on outcomes of neurotized autologous breast reconstruction using a nerve graft and conduit technique. The authors’ approach resulted in improved sensory outcomes compared to those in patients who did not undergo sensory reconstruction. Importantly, factors that can interfere with sensory recovery were identified. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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“…10,17,24,25 These observations are contrasted by few studies that have failed to demonstrate such a difference in outcomes. 17,26–28…”

Section: Introductionmentioning

confidence: 99%

Anatomical Considerations to Optimize Sensory Recovery in Breast Neurotization with Allograft

Dučić

Yoon

Momeni

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Breast numbness is a recognized problem following mastectomy and subsequent reconstruction. Contemporary literature acknowledges the positive role of breast neurotization, but it is characterized by a variety of technical approaches and substantial heterogeneity with respect to the degree of recovered sensibility that remains suboptimal in comparison with other sensory nerve reconstructions. This study’s purpose was to provide an anatomical basis for observed inconsistencies and therein provide a principle that can be used to develop a technical approach that will optimize sensory recovery.Methods:Anatomical dissections on 6 fresh cadavers, that is, 12 hemi-abdominal flaps and 12 hemi-chest dissections, were performed. The technical aspects of harvesting the abdominal flap with a nerve target, that is, inclusion of a sensory nerve branch only, recipient nerves in the chest, and the applications of allograft for acquired nerve gap reconstruction were investigated.Results:Abdominal flaps that include sensory-only intercostal nerve 10–12 segments and identification of recipient chest wall intercostal nerves 2–4 could be consistently performed. The dissection and extraction of the donor sensory nerve target allowed preservation of the motor rectus innervation. The acquired nerve gap was easily bridged by an interposing allograft, allowing free arch of rotation for flap inset, suitable for either single or dual neurotization.Conclusions:We provide a likely anatomical explanation for suboptimal sensory recovery after deep inferior epigastric perforator (DIEP) flap breast neurotization, as mixed intercostal autograft is prohibitive to maximal sensory recovery. Breast neurotization with allograft that bridges sensory donor intercostal nerves to sensory recipient intercostal nerves should anatomically optimize restoration of breast sensibility.

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Spontaneous Reinnervation of Deep Inferior Epigastric Perforator Flaps after Delayed Breast Reconstruction

Abstract: This study provides certain predictions for patients and surgeons, when and to which extent spontaneous reinnervation can be expected.

Cited by 18 publications

References 21 publications

Standardized Quantitative Sensory Testing to assess insufficient recovery of touch discrimination in free flap surgery in extremity reconstruction

Standardized Quantitative Sensory Testing to assess insufficient recovery of touch discrimination in free flap surgery in extremity reconstruction

Sensory restoration in abdominally-based free flap for breast reconstruction using nerve allograft

Anatomical Considerations to Optimize Sensory Recovery in Breast Neurotization with Allograft

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