Susceptibility of the Insensate Reconstructed Breast to Burn Injury

Bhatnagar, Arun

doi:10.1097/00006534-199703000-00069

Cited by 26 publications

(9 citation statements)

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“…The insensate flap relies on the sensation of adjacent tissues for warnings of potential thermal or traumatic insults. Despite this potential protection, all of our cases and the majority of previously reported cases, [1][2][3][4][5][6]29 describe sparing of surrounding tissues. This further supports the hypothesis that the cutaneous tissues of a flap are inherently more susceptible to thermal insult than innervated skin.…”

Section: Discussioncontrasting

confidence: 47%

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Thermal injuries in the insensate deep inferior epigastric artery perforator flap: Case series and literature review on mechanisms of injury

et al. 2009

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With the increasing use of the deep inferior epigastric artery perforator (DIEP) flap, complications that are particularly rare (less than 1%) may start to become clinically relevant. During DIEP flap harvest, cutaneous nerves innervating the flap are necessarily sacrificed, resulting in reduced sensibility. This impaired sensibility prevents adequate thermoregulatory reflexes, like vasodilatation, sweating, and protective behaviors, leaving the reconstructed breast considerably more susceptible to thermal insult. We present four DIEP flap cases who sustained postoperative thermal injury to the reconstructed breast. All four cases were operated on between 2001 and 2008, over the course of 600 DIEP flaps in our unit (an incidence of 0.7%). The injuries occurred between 2 and 18 months after reconstruction. Two patients sustained thermal injury while sunbathing, one while staying in a warm environment, and one sustained the injury while taking a shower. No flap losses ensued, but these were not without morbidity. A literature review discusses other similar cases in the literature and describes the mechanisms for these findings. As a majority of patients will regain both fine-touch and heat sensation by 3 years postoperatively, it is pertinent that prophylactic measures be instituted during this period, such as the avoidance of sunbathing and the use of cooler shower temperatures for the first 3 years postoperatively. While performing sensory nerve coaptation is the gold standard for maximizing the success of sensory regeneration, this is not always sought and the 0.7% incidence of thermal injury we have encountered suggest the role for greater consideration of such injury.

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Section: Discussioncontrasting

confidence: 47%

“…[1][2][3][4][5][6] In these cases, exposure to solar radiation and heat sources, not considered hazardous, have resulted in potentially irreversible damage to the flap, in some cases requiring further flap surgery. We present four DIEP flap cases who sustained postoperative thermal injury to the reconstructed breast.…”

mentioning

confidence: 99%

Thermal injuries in the insensate deep inferior epigastric artery perforator flap: Case series and literature review on mechanisms of injury

et al. 2009

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“…Following myocutaneous flap breast reconstruction both the flap and its donor site are rendered susceptible to thermal injury as a result of the sensory and autonomic thermoregulatory changes that occur 1–3. Disruption of the autonomic pathways renders the skin incapable of effectively dissipating a heat load and loss of pain fibres prevents the patient from mounting a protective behavioural response by withdrawing from the painful stimulus 1 4…”

Section: Discussionmentioning

confidence: 99%

“…While the vulnerability of the reconstructed breast has been highlighted by case reports,1–3 only burns to the abdominal donor site have been described, and none to the latissimus dorsi donor site.…”

Section: Discussionmentioning

confidence: 99%

Full thickness burn to a latissimus dorsi flap donor site due to a heat pad - there is still a need to improve patient information

Foulkes

Davidson²,

Gateley³

2011

Case Reports

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“…Due to the dissection plane necessary to adequately remove breast tissue in an oncologically safe and effective way, both of these avenues of sensory innervation are at high risk for injury or loss during the mastectomy . There have been varying degrees of returned sensation described post‐mastectomy and the loss of protective and erogenous sensation has shown to negatively impact quality of life outcomes …”

Section: Breast Anatomical Considerationsmentioning

confidence: 99%

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

2019

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Breast cancer is the most commonly diagnosed invasive cancer in women worldwide. While hypoesthesia is a known sequela after mastectomy, patients are now inquiring with renewed interest about the degree and timing of sensation after mastectomy. This is a topic that has generated much research interest. However, while there have been advances in the field, there are few, well‐done studies that allow for an accurate answer to this question. In this article, relevant breast and donor site anatomy is reviewed for sensate autologous breast reconstruction. Additional donor sites apart from the typically utilized abdomen are analyzed with relevant anatomical discussions. Outcomes are presented; however, due to the heterogeneity of the patient population, surgical approach and postoperative sensory testing, it is difficult to compare results between studies. Future directions and unanswered questions regarding sensate autologous breast reconstruction are highlighted. While great strides have been made in providing sensate autologous breast reconstruction, there are still many unanswered questions. Thus, the collaboration between surgical teams and sharing of outcomes is crucial to allow for optimization of this powerful surgical approach.

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Susceptibility of the Insensate Reconstructed Breast to Burn Injury

Cited by 26 publications

References 0 publications

Thermal injuries in the insensate deep inferior epigastric artery perforator flap: Case series and literature review on mechanisms of injury

Thermal injuries in the insensate deep inferior epigastric artery perforator flap: Case series and literature review on mechanisms of injury

Full thickness burn to a latissimus dorsi flap donor site due to a heat pad - there is still a need to improve patient information

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

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