The role of neurotization in autologous breast reconstruction: Can reconstruction restore breast sensation?

Vartanian, Emma; Lo, Andrea Y.; Hershenhouse, Korri S.; Jacob, Laya; Patel, Ketan M.

doi:10.1002/jso.26422

Cited by 16 publications

(20 citation statements)

References 41 publications

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“…In breast reconstruction, several authors have described faster recovery and superior sensory reinnervation in neurotized free flaps. 7–9,11–16 Similarly, in extremity reconstruction, previous studies describe overall diminished sensory recovery gradually improving over time 2,10,17,18 and faster recovery in neurotized flaps. 10 In contrast, in oral cavity reconstruction using radial forearm flaps and latissimus dorsi flaps, sensory reinnervation has been shown in neurotized and nonneurotized flaps 19–21 with some authors reporting no superior improvement in flaps with nerval reconstruction.…”

mentioning

confidence: 80%

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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mentioning

confidence: 80%

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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show abstract

“…The deep inferior epigastric perforator flap (DIEP) is also described to be available for neurotization. The nerve branches of intercostal nerves are described as following the arteriovenous perforators [ 14 ]. Yet, this flap is usually bulkier than the above-described options, and applications for distal extremity reconstruction are, therefore, limited.…”

Section: Neurotizable Workhorse Flapsmentioning

confidence: 99%

Hopeless Neuroma—The Neurotized Free Flap Tissue Augmentation as Salvage Therapy—A Concept and Clinical Demonstration

Aman

Glaser

Thielen

et al. 2023

JPM

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Therapy-resistant neuroma pain is a devastating condition for patients and surgeons. Although various methods are described to surgically deal with neuromas, some discontinuity and stump neuroma therapies have anatomical limitations. It is widely known that a neurotizable target for axon ingrowth is beneficial for dealing with neuromas. The nerve needs “something to do”. Furthermore, sufficient soft tissue coverage plays a major role in sufficient neuroma therapy. We aimed, therefore, to demonstrate our approach for therapy of resistant neuromas with insufficient tissue coverage using free flaps, which are sensory neurotized via anatomical constant branches. The central idea is to provide a new target, a new “to do” for the painful mislead axons, as well as an augmentation of deficient soft tissues. As indication is key, we furthermore demonstrate clinical cases and common neurotizable workhorse flaps.

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“…However, referring to Bijkerk et al 3 would have been appropriate when discussing the length of the procedure. Vartanian et al 1 reported that the overall success in this procedure varies between 65% and 95% and that it increases surgery duration by at least 30 min. An increased surgery duration is to be expected when a double neurorrhaphy is performed and even more so when nerve grafts are required.…”

Section: E T T E R T O T H E E D I T O Rmentioning

confidence: 99%

Comment: “The role of neurotization in autologous breast reconstruction: Can reconstruction restore breast sensation?”

Mernier

Serror

Chaouat

et al. 2021

Journal of Surgical Oncology

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The role of neurotization in autologous breast reconstruction: Can reconstruction restore breast sensation?

Cited by 16 publications

References 41 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

Hopeless Neuroma—The Neurotized Free Flap Tissue Augmentation as Salvage Therapy—A Concept and Clinical Demonstration

Comment: “The role of neurotization in autologous breast reconstruction: Can reconstruction restore breast sensation?”

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