Yap Lok H, Whiten Susan C, Forster Alan, Stevenson Howard J
Department of Plastic and Reconstructive Surgery, M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Plast Reconstr Surg. 2005 Apr 15;115(5):1280-8. doi: 10.1097/01.prs.0000156988.78391.d6.
Preservation and restoration of sensation to improve the quality of the reconstruction have not always been considered a priority in efforts to reconstruct the breast. Studies have documented spontaneous recovery of sensation in reconstructed breasts, but this recovery was variable and unpredictable. The authors conducted a pilot study to compare sensory recovery in innervated versus noninnervated microsurgical breast reconstruction patients.
The authors investigated a group of 14 patients who had undergone microsurgical breast reconstruction with a muscle-sparing free transverse rectus abdominis myocutaneous flap. Seven patients had reinnervation of their flaps, and seven did not. The two patient groups were similar in age (mean age, 46 years for the innervated group and 51 years for the noninnervated group) and length of follow-up (mean duration of follow-up, 39 months for the innervated group and 40 months for the noninnervated group). Sensitivity to fine touch was assessed using Semmes-Weinstein monofilaments. By testing over a defined grid and over the entire reconstructed breast, it was possible to develop color maps, or sensory topograms, of the areas sensing different levels of pressure for each patient. The patient's ability to differentiate between hot (60 degrees C) and cold (5 degrees C) was recorded.
In a comparison of sensation in flap skin (skin paddle of rectus abdominis myocutaneous flap) with nonflap skin (native breast skin), sensitivity to fine touch was statistically better in (1) innervated flap skin compared with noninnervated flap skin (p = 0.003), (2) innervated nonflap skin compared with noninnervated flap skin (p = 0.006), (3) innervated nonflap skin compared with noninnervated nonflap skin (p = 0.037), and (4) innervated flap skin compared with noninnervated nonflap skin (p = 0.006). Temperature differentiation was significantly better in patients with innervated flaps than in patients with noninnervated flaps in all zones (p = 0.02). These differences persisted beyond a follow-up period of 3 years.
The authors' findings confirm that reinnervation of microsurgically reconstructed breasts achieves sensory recovery that is superior to that in breasts reconstructed without reinnervation. If sensation is important and the anatomical factors are favorable, reinnervation may represent a worthwhile refinement in attempts to achieve normality for patients undergoing breast reconstruction.
在乳房重建过程中，保留和恢复感觉以提高重建质量并非一直被视为首要任务。研究记录了重建乳房感觉的自发恢复情况，但这种恢复是可变且不可预测的。作者进行了一项前瞻性研究，以比较接受神经支配与未接受神经支配的显微外科乳房重建患者的感觉恢复情况。
作者调查了一组14例接受显微外科乳房重建的患者，采用保留肌肉的游离腹直肌肌皮瓣。7例患者的皮瓣进行了神经再支配，7例未进行。两组患者年龄相似（神经支配组平均年龄46岁，未神经支配组平均年龄51岁），随访时间相近（神经支配组平均随访时间39个月，未神经支配组平均随访时间40个月）。使用Semmes-Weinstein单丝评估对精细触觉的敏感性。通过在定义的网格上以及整个重建乳房上进行测试，可以为每位患者绘制出感知不同压力水平区域的彩色地图或感觉地形图。记录患者区分热（60摄氏度）和冷（5摄氏度）的能力。
在比较皮瓣皮肤（腹直肌肌皮瓣的皮岛）与非皮瓣皮肤（天然乳房皮肤）的感觉时，对精细触觉的敏感性在以下方面在统计学上更好：（1）神经支配的皮瓣皮肤与未神经支配的皮瓣皮肤相比（p = 0.003）；（2）神经支配的非皮瓣皮肤与未神经支配的皮瓣皮肤相比（p = 0.006）；（3）神经支配的非皮瓣皮肤与未神经支配的非皮瓣皮肤相比（p = 0.037）；（4）神经支配的皮瓣皮肤与未神经支配的非皮瓣皮肤相比（p = 0.006）。在所有区域，神经支配皮瓣的患者温度辨别能力明显优于未神经支配皮瓣的患者（p = 0.02）。这些差异在随访3年后仍然存在。
作者的研究结果证实，显微外科重建乳房的神经再支配实现的感觉恢复优于未进行神经再支配的乳房重建。如果感觉很重要且解剖学因素有利，那么神经再支配对于试图为接受乳房重建的患者实现正常状态可能是一项有价值的改进措施。
