Cornelissen Anouk J M, Beugels Jop, Lataster Arno, Heuts Esther M, Rozen Shai M, Spiegel Aldona J, van der Hulst René R W J, Tuinder Stefania M H
Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center +, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Department of Anatomy and Embryology, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht. The Netherlands.
J Plast Reconstr Aesthet Surg. 2018 Mar;71(3):327-335. doi: 10.1016/j.bjps.2017.09.011. Epub 2017 Sep 25.
Autologous breast reconstruction has become the standard care for breast cancer patients. Although excellent cosmetic results can be achieved, most reconstructed breasts fail to regain normal sensation. Nerve coaptation of the flap has been suggested to improve sensation; the effect of the donor flap native sensory threshold on the degree of sensory restoration is yet to be determined. The aim of this study is to evaluate the differences in sensation between various potential donor site regions in comparison to the sensation of the healthy breast.
A cross-sectional study in healthy women was performed in the Maastricht University Medical Centre. Monofilaments were used to measure sensation in the breast and at different flap donor sites: deep inferior epigastric perforator (DIEP), lateral thigh perforator (LTP), profunda artery perforator (PAP), superior gluteal artery perforator (SGAP) and transverse musculocutaneous gracilis (TMG) flaps. The Wilcoxon signed rank test was used to analyse statistical significance in sensation.
Fifty women with a mean age of 49 ± 2.72 years and mean BMI of 26.14 ± 0.89 kg/m were included in the study. The median monofilament value of the normal breasts was 2.97(2.56-3.55). The median monofilament value of each donor site and p value when compared to the healthy breast were as follows: DIEP flap, 2.62 (2.36-3.22) p < 0.01; LTP flap, 3.61 (2.83-4.08) p <0.01; PAP flap, 3.09 (2.67-3.5) p = 0.97; SGAP flap, 3.22 (2.64-3.87) p = 0.01; and TMG flap, 3.03 (2.6-3.47) p = 0.69.
There is a significant difference in sensation between the various donor site regions for breast reconstruction and the healthy breast. This may be taken into consideration for donor site selection.
自体乳房重建已成为乳腺癌患者的标准治疗方法。尽管可以获得出色的美容效果，但大多数重建乳房无法恢复正常感觉。有人建议通过皮瓣的神经吻合来改善感觉；供体皮瓣的天然感觉阈值对感觉恢复程度的影响尚待确定。本研究的目的是评估各种潜在供区与健康乳房感觉之间的差异。
在马斯特里赫特大学医学中心对健康女性进行了一项横断面研究。使用单丝测量乳房和不同皮瓣供区的感觉：腹壁下深动脉穿支（DIEP）皮瓣、股外侧穿支（LTP）皮瓣、旋股深动脉穿支（PAP）皮瓣、臀上动脉穿支（SGAP）皮瓣和股薄肌肌皮瓣（TMG）。采用Wilcoxon符号秩检验分析感觉的统计学意义。
50名平均年龄为49±2.72岁、平均BMI为26.14±0.89kg/m的女性纳入研究。正常乳房的单丝值中位数为2.97（2.56 - 3.55）。与健康乳房相比，每个供区的单丝值中位数及p值如下：DIEP皮瓣，2.62（2.36 - 3.2），p < 0.01；LTP皮瓣，3.61（2.83 - 4.08），p < 0.01；PAP皮瓣，3.09（2.67 - 3.5），p = 0.97；SGAP皮瓣，3.22（2.64 - 3.87），p = 0.01；TMG皮瓣，3.03（2.6 - 3.47），p = 0.69。
乳房重建的各个供区与健康乳房之间在感觉上存在显著差异。在选择供区时可考虑这一点。
