Rome, Italy From the Plastic Surgery Unit, Sant' Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome.
Plast Reconstr Surg. 2011 May;127(5):1790-1795. doi: 10.1097/PRS.0b013e31820cf1c6.
The deep inferior epigastric perforator (DIEP) flap is considered the definitive standard for autologous breast reconstruction because of its ability to restore shape, its consistency, and its static and dynamic symmetry, but the degree of spontaneous sensory recovery is still widely discussed. To clarify the real need for sensitive nerve coaptation, return of sensibility in DIEP flaps was investigated using a pressure-specifying sensory device.
Thirty consecutive patients with breast cancer scheduled for modified radical mastectomy, axillary node dissection, and immediate reconstruction with cutaneous-adipose DIEP flaps without nerve repair were enrolled in the study. Sensibility for one and two points, static and moving, was tested preoperatively on the breasts and abdomen, and postoperatively at 6 and 12 months on the DIEP flaps. A t test was used for comparison of paired data and to investigate which factors affected sensory recovery.
Preoperative healthy breast and abdomen pressure thresholds were lower for two-point than one-point discrimination and for moving discriminations compared with static ones at 6 and 12 months. Although they were significantly higher than those for contralateral healthy breasts (p < 0.05), pressure thresholds in DIEP flaps at 12 months were lower than at 6 months, showing a significant progressive sensory recovery (p < 0.05). At 12 months postoperatively, the best sensibility recovery was found at the inferior lateral quadrant, the worst at the superior medial quadrant. Age and flap weight were factors related to the performance of sensory recovery.
DIEP flap transfer for immediate breast reconstruction undergoes satisfactory progressive spontaneous sensitive recovery at 6 and 12 months after surgery, and operative time spent dissecting sensitive perforator branches and their coaptation in recipient site could be spared.
由于能够恢复形状、具有一致性以及静态和动态对称性，深部腹壁下血管穿支皮瓣（DIEP）被认为是自体乳房重建的标准方法，但自发性感觉恢复的程度仍存在广泛争议。为了明确对敏感神经吻合的实际需求，本研究使用压力敏感装置来研究 DIEP 皮瓣的感觉恢复情况。
连续纳入 30 例接受改良根治性乳房切除术、腋窝淋巴结清扫术和即刻 DIEP 皮瓣修复的乳腺癌患者，皮瓣为带皮肤和脂肪的游离组织瓣，不进行神经修复。术前对乳房和腹部进行 1 点和 2 点辨别觉、静态和动态辨别觉测试，术后 6 个月和 12 个月对 DIEP 皮瓣进行测试。采用配对 t 检验比较组内数据，并分析哪些因素影响感觉恢复。
术前健康乳房和腹部的两点辨别觉和动态辨别觉的压力阈值低于 6 个月和 12 个月的 1 点辨别觉，且均显著低于对侧健康乳房（p<0.05），但 12 个月时 DIEP 皮瓣的压力阈值低于 6 个月，表明存在明显的感觉逐渐恢复（p<0.05）。术后 12 个月时，下外侧象限的感觉恢复最好，上内侧象限的感觉恢复最差。年龄和皮瓣重量是影响感觉恢复的因素。
DIEP 皮瓣游离移植即刻乳房重建术后 6 个月和 12 个月可获得满意的自发性敏感感觉恢复，可避免在受区解剖和吻合感觉穿支血管分支的手术时间。
