Schroegendorfer Klaus F, Hacker Stefan, Nickl Stefanie, Vierhapper Martin, Nedomansky Jakob, Haslik Werner
Vienna, Austria From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University Vienna.
Plast Reconstr Surg. 2014 Dec;134(6):1125-1129. doi: 10.1097/PRS.0000000000000739.
The latissimus dorsi muscle flap represents a valuable option in breast reconstruction but can result in postoperative twitching and retraction, discomfort, arm movement limitations, and breast deformation. These complications can be avoided by denervation of the thoracodorsal nerve; however, the optimal method of nerve management is unknown. This study presents the authors' experience with the outcomes of latissimus dorsi flaps for breast reconstruction in the light of thoracodorsal nerve management strategies.
The authors retrospectively collected data from 74 patients who underwent partial or total breast reconstruction with a latissimus dorsi flap alone or with an implant between January of 1999 and October of 2011. Follow-up data were collected at 12 and 24 months postoperatively.
In 56 patients (75.7 percent), the latissimus dorsi muscle was denervated at the time of surgery, whereas the thoracodorsal nerve remained intact in 18 patients (24.3 percent). No partial or total flap loss was observed. At 12 and 24 months' follow-up, all patients with an intact thoracodorsal nerve showed twitching of the muscle, and 50 percent and 67.9 percent, respectively, of the denervated patients showed twitching (p < 0.001). No patient had twitching if more than 4 cm of nerve was excised at 12 or 24 months postoperatively, and the length of nerve resection was predictive of the presence of twitching.
Denervation of the latissimus dorsi is a safe and reliable procedure that should be performed at the time of breast reconstruction and should include more than 4 cm to achieve a nontwitching breast with a stable volume and shape.
背阔肌肌皮瓣是乳房重建的一种重要选择，但术后可能导致肌肉抽搐、收缩、不适、手臂活动受限及乳房变形。通过胸背神经去神经支配可避免这些并发症；然而，神经处理的最佳方法尚不清楚。本研究根据胸背神经管理策略，介绍作者应用背阔肌肌皮瓣进行乳房重建的经验。
作者回顾性收集了1999年1月至2011年10月期间74例行单纯背阔肌肌皮瓣或联合植入物进行部分或全乳房重建患者的数据。术后12个月和24个月收集随访数据。
56例患者（75.7%）在手术时对背阔肌进行了去神经支配，18例患者（24.3%）胸背神经保持完整。未观察到部分或全部皮瓣丢失。在12个月和24个月随访时，所有胸背神经完整的患者均出现肌肉抽搐，而去神经支配患者分别有50%和67.9%出现抽搐（p<0.001）。术后12个月或24个月切除神经超过4 cm时无患者出现抽搐，神经切除长度可预测抽搐的发生。
背阔肌去神经支配是一种安全可靠的手术，应在乳房重建时进行，且切除长度应超过4 cm，以获得体积和形状稳定且无抽搐的乳房。
