Kääriäinen Minna, Giordano Salvatore, Kauhanen Susanna, Helminen Mika, Kuokkanen Hannu
Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland.
Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
J Plast Reconstr Aesthet Surg. 2014 Aug;67(8):1106-10. doi: 10.1016/j.bjps.2014.04.029. Epub 2014 May 13.
It has been shown that the myocutaneous latissimus dorsi flap volume and consistency remain mainly the same regardless the nerve is cut or not in breast reconstruction. It is controversial how big an impact the flap innervation has on the muscle activity of the flap. The aim of the study was to prospectively evaluate the influence of latissimus dorsi flap innervation on the functional and aesthetic outcome of delayed breast reconstruction.
Between 2007 and 2008, 28 breast reconstructions were performed and randomly divided into denervation group (surgical denervation by excision of 1 cm of proximal thoracodorsal nerve, n=14) and innervation group (thoracodorsal nerve saved intact, n=14). Patients were clinically evaluated and a questionnaire considering functional and aesthetic outcome was filled 1-year after operation. Muscular twitching, pain, tightness, shape and symmetry of the breasts were evaluated. In addition, the mobility of the shoulder joint on the operated side was evaluated and the patients self-estimated the activities of daily living.
There was no significant difference in latissimus dorsi flap twitching, pain and tightness of the breast and symmetry and shape of the breasts between denervated and innervated groups. The shoulder joint mobility was not found to be changed significantly in either of the groups and there were no limitations in activities of daily living.
Thoracodorsal nerve division or preservation does not significantly affect muscle contraction activity of the latissimus dorsi flap and distortion of the breast when latissimus dorsi muscle humeral insertion is also detached. Therefore, both cutting and saving the nerve are justified in latissimus dorsi flap breast reconstruction depending on whether the humeral insertion of the muscle is preserved intact or divided and the flap islanded. The study shows that there is no tangible benefit in dividing the nerve when the flap is islanded. Clinical trial has been registered in public trials registry. Trial registry name is 'The significance of latissimus dorsi flap innervation in delayed breast reconstruction'. Registration number is NCT01239524 and URL is https://register.clinicaltrials.gov.
研究表明，在乳房重建中，无论胸背神经是否切断，背阔肌肌皮瓣的体积和质地基本保持不变。皮瓣神经支配对皮瓣肌肉活动的影响程度存在争议。本研究的目的是前瞻性评估背阔肌皮瓣神经支配对延迟性乳房重建功能和美学效果的影响。
2007年至2008年期间，共进行了28例乳房重建手术，并随机分为去神经组（通过切除1cm近端胸背神经进行手术去神经，n = 14）和神经保留组（胸背神经完整保留，n = 14）。术后1年对患者进行临床评估，并填写一份关于功能和美学效果的问卷。评估肌肉抽搐、疼痛、紧绷感、乳房形状和对称性。此外，评估患侧肩关节的活动度，并让患者自我评估日常生活活动能力。
去神经组和神经保留组在背阔肌皮瓣抽搐、乳房疼痛和紧绷感以及乳房对称性和形状方面均无显著差异。两组的肩关节活动度均未发现有明显变化，日常生活活动也没有受到限制。
当背阔肌肱骨止点也被分离时，切断或保留胸背神经对背阔肌皮瓣的肌肉收缩活动和乳房变形没有显著影响。因此，在背阔肌皮瓣乳房重建中，根据肌肉肱骨止点是完整保留还是切断以及皮瓣是否形成岛状，切断或保留神经都是合理的。研究表明，当皮瓣形成岛状时，切断神经并没有明显的益处。本临床试验已在公共试验注册库注册。试验注册名称为“背阔肌皮瓣神经支配在延迟性乳房重建中的意义”。注册号为NCT01239524，网址为https://register.clinicaltrials.gov。
