Paolini Guido, Longo Benedetto, Laporta Rosaria, Sorotos Michail, Amoroso Matteo, Santanelli Fabio
From the Plastic Surgery Chair, Faculty of Medicine and Psychology, University of Rome "Sapienza," Rome, Italy.
Ann Plast Surg. 2013 Dec;71(6):639-42. doi: 10.1097/SAP.0b013e31825c0840.
A retrospective analysis of our series of denervated latissimus dorsi (LD) breast reconstructions showed a high incidence of postoperative LD contraction. Anatomical studies with a prospective clinical trial are set up to outline a successful denervation procedure.
Fifteen fresh cadavers were dissected to study thoracodorsal nerve course. Subsequently, 40 consecutive LD breast reconstructions were divided randomly in equal groups and underwent either distal (group A) or proximal (group B) nerve resection and clipping. The presence of postoperative contraction was evaluated clinically and instrumentally at 2-year follow-up. Statistical analysis of data was performed by Fisher exact test.
Cadaver dissections showed distal branching of thoracodorsal nerve in 20% of cases. Incidence of postoperative LD contraction was 35% (7/20) in group A and 0% in group B. A significantly lower rate of contraction in group B was demonstrated (P = 0.004).
Type B proximal nerve resection allows for effective denervation reducing incidence of postoperative contraction (P = 0.004).
对我们一系列去神经支配的背阔肌（LD）乳房重建病例进行回顾性分析显示，术后LD挛缩发生率很高。开展了一项带有前瞻性临床试验的解剖学研究，以勾勒出一种成功的去神经支配手术方法。
解剖15具新鲜尸体以研究胸背神经走行。随后，将40例连续的LD乳房重建病例随机分为两组，分别进行远端（A组）或近端（B组）神经切除并结扎。在2年随访时通过临床和仪器检查评估术后挛缩情况。采用Fisher精确检验对数据进行统计学分析。
尸体解剖显示20%的病例中胸背神经有远端分支。A组术后LD挛缩发生率为35%（7/20），B组为0%。B组挛缩率显著更低（P = 0.004）。
B型近端神经切除可实现有效的去神经支配，降低术后挛缩发生率（P = 0.004）。
