London, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Lawson Health Research Institute, University of Western Ontario.
Plast Reconstr Surg. 2009 Nov;124(5):1419-1425. doi: 10.1097/PRS.0b013e3181b98963.
Restoring sensory innervation may be a useful adjunct in free flap head and neck reconstruction but, as yet, has not been shown to improve outcomes of breast reconstruction. The authors' previous study demonstrated objectively improved sensation in a group of innervated transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction patients relative to noninnervated flaps. This study compared patient-rated outcomes of free TRAM breast reconstruction in innervated versus noninnervated flaps.
Twenty-seven women were randomized prospectively to undergo either innervated or noninnervated free TRAM flap breast reconstruction. For innervated flaps, the T10 intercostal nerve was harvested with the TRAM flap and neurotized to the T4 sensory nerve at the recipient site. Three validated outcome tools were administered after surgery: the Medical Outcomes Study 36-Item Short Form Health Survey, the Body Image after Breast Cancer Questionnaire, and the Functional Assessment of Cancer Therapy-Breast. Results were correlated with previously reported objective sensibility outcomes.
Eighteen of 27 women returned their questionnaires a mean 48 months after free TRAM flap reconstruction. Demographic analysis revealed no significant differences in patient age, height, smoking, radiation therapy, and nipple-areola complex reconstruction between randomized patient groups. There was a statistically significant improvement in all three measures in patients who were randomized to receive innervated free TRAM flaps compared with those receiving noninnervated flaps.
This study demonstrates that innervation of free TRAM flaps used for breast reconstruction not only improves sensibility but also has a positive effect on patient-rated quality of life.
恢复感觉神经支配可能是游离皮瓣头颈部重建的有用辅助手段，但迄今为止，尚未显示其能改善乳房重建的结果。作者之前的研究表明，与非神经化皮瓣相比，一组神经化横行腹直肌肌皮瓣（TRAM）乳房重建患者的感觉确实得到了客观改善。本研究比较了神经化与非神经化游离 TRAM 乳房重建患者的患者报告结局。
27 名女性前瞻性随机分为接受神经化或非神经化游离 TRAM 皮瓣乳房重建。对于神经化皮瓣，从 TRAM 皮瓣中取出 T10 肋间神经，并在受体部位将其神经化至 T4 感觉神经。手术后使用三种经过验证的结果工具进行评估：医疗结果研究 36 项简明健康调查、乳腺癌后身体形象问卷和癌症治疗-乳房功能评估。结果与之前报道的客观感觉结果相关。
18 名 27 名女性在游离 TRAM 皮瓣重建后平均 48 个月返回了他们的问卷。人口统计学分析显示，在接受随机分组的患者群体中，患者年龄、身高、吸烟、放射治疗和乳头乳晕复合体重建没有显著差异。与接受非神经化皮瓣的患者相比，接受神经化游离 TRAM 皮瓣的患者在所有三个测量指标上均有统计学显著改善。
本研究表明，游离 TRAM 皮瓣用于乳房重建不仅可以提高感觉，而且对患者报告的生活质量有积极影响。
