Savonlinna, Turku, and Lappeenranta, Finland From the Departments of Surgery and Clinical Neurophysiology, Savonlinna Central Hospital; the Department of Clinical Neurophysiology, Turku University Hospital; and the Department of Surgery, South Karelia Central Hospital.
Plast Reconstr Surg. 2012 Sep;130(3):392e-397e. doi: 10.1097/PRS.0b013e31825dbedd.
Classic abdominoplasty for a transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction impairs abdominal somatosensory function at the donor site. The aim of this study was to investigate whether the type of surgical procedure has an effect on somatosensory alterations of abdominal skin after TRAM flap breast reconstruction.
Sixty patients (mean ± SD age, 50 ± 6.0 years) who underwent microvascular TRAM flap breast reconstruction and 20 healthy subjects (control group; mean age, 46 ± 6.7 years) participated in the study. Twenty patients had bilateral-nerve anastomosis, 20 had single-nerve anastomosis, and 20 underwent no nerve dissection for the TRAM flap. Clinical sensory examination and tactile and thermal quantitative sensory testing were performed and a patient questionnaire was administered at a mean of 2 to 4.5 years after surgery.
All surgical techniques produced significant sensory impairment below the umbilicus, but there were no significant differences in total sensibility scores between the groups with single-nerve (mean sensibility score, 21.98 ± 2.7) and double-nerve (mean sensibility score, 20.71 ± 3.6) anastomosis of the TRAM flap. The best sensibility scores were found in the group with single-nerve dissection. Fifteen percent of patients complained of mild pain, and 13 percent felt occasional tactile hyperesthesia in their abdominal skin, mostly around the umbilicus and scars.
In this study, unilateral or bilateral nerve dissection when preparing and lifting a TRAM flap did not seem to increase sensory alterations or postoperative pain in the abdominal donor site after breast reconstruction surgery. Cautious microneurovascular dissection techniques may even improve sensory recovery of the abdominal skin after TRAM flap breast reconstruction surgery.
经典的腹直肌肌皮瓣（TRAM）乳房重建术会损害供区腹部的躯体感觉功能。本研究旨在探讨手术方式是否会影响 TRAM 皮瓣乳房重建术后腹部皮肤的感觉改变。
60 例（平均年龄 ± 标准差，50 ± 6.0 岁）接受微血管 TRAM 皮瓣乳房重建术的患者和 20 例健康受试者（对照组；平均年龄，46 ± 6.7 岁）参与了这项研究。20 例患者行双神经吻合术，20 例患者行单神经吻合术，20 例患者行 TRAM 皮瓣无神经解剖术。术后平均 2 至 4.5 年，进行临床感觉检查、触觉和温度定量感觉测试，并对患者进行问卷调查。
所有手术技术均导致脐以下部位感觉明显受损，但单神经（平均感觉评分 21.98 ± 2.7）和双神经（平均感觉评分 20.71 ± 3.6）吻合的 TRAM 皮瓣组之间的总感觉评分无显著差异。单神经解剖组的感觉评分最佳。15%的患者诉轻度疼痛，13%的患者诉腹部皮肤偶有触痛感，主要在脐周和瘢痕处。
在这项研究中，在准备和提起 TRAM 皮瓣时行单侧或双侧神经解剖似乎不会增加乳房重建术后腹部供区的感觉改变或术后疼痛。谨慎的显微血管神经解剖技术甚至可能改善 TRAM 皮瓣乳房重建术后腹部皮肤的感觉恢复。
