From the Department of Plastic, Reconstructive and Hand Surgery, GROW-School for Oncology and Developmental Biology, the Department of Clinical Epidemiology and Medical Technology Assessment, and the Department of Surgery, Maastricht University Medical Center; the Department of Anatomy and Embryology, Maastricht University; and the Center for Breast Restoration, Institute for Reconstructive Surgery, Houston Methodist Hospital.
Plast Reconstr Surg. 2019 Aug;144(2):178e-188e. doi: 10.1097/PRS.0000000000005802.
The sensory recovery of the breast remains an undervalued aspect of autologous breast reconstruction. The aim of this study was to evaluate the effect of nerve coaptation on the sensory recovery of the breast following DIEP flap breast reconstruction and to assess the associations of length of follow-up and timing of the reconstruction.
A prospective comparative study was conducted of all patients who underwent either innervated or noninnervated DIEP flap breast reconstruction and returned for follow-up between September of 2015 and July of 2017. Nerve coaptation was performed to the anterior cutaneous branch of the third intercostal nerve. Semmes-Weinstein monofilaments were used for sensory testing of the native skin and flap skin.
A total of 48 innervated DIEP flaps in 36 patients and 61 noninnervated DIEP flaps in 45 patients were tested at different follow-up time points. Nerve coaptation was significantly associated with lower monofilament values in all areas of the reconstructed breast (adjusted difference, -1.2; p < 0.001), which indicated that sensory recovery of the breast was significantly better in innervated compared with noninnervated DIEP flaps. For every month of follow-up, the mean monofilament value decreased by 0.083 in innervated flaps (p < 0.001) and 0.012 in noninnervated flaps (p < 0.001). Nerve coaptation significantly improved sensation in both immediate and delayed reconstructions.
This study demonstrated that nerve coaptation in DIEP flap breast reconstruction is associated with a significantly better sensory recovery in all areas of the reconstructed breast compared with noninnervated flaps. The length of follow-up was significantly associated with the sensory recovery.
乳房的感觉恢复仍然是自体乳房重建中被低估的一个方面。本研究旨在评估神经吻合对 DIEP 皮瓣乳房重建后乳房感觉恢复的影响，并评估随访时间和重建时间的相关性。
对 2015 年 9 月至 2017 年 7 月间接受神经吻合或非神经吻合 DIEP 皮瓣乳房重建并进行随访的所有患者进行前瞻性比较研究。神经吻合采用第三肋间前皮支。使用 Semmes-Weinstein 单丝进行皮瓣皮肤和原生皮肤的感觉测试。
共有 36 名患者的 48 个神经吻合的 DIEP 皮瓣和 45 名患者的 61 个非神经吻合的 DIEP 皮瓣在不同的随访时间点进行了测试。神经吻合与重建乳房各部位的单丝值较低显著相关（调整差异，-1.2；p<0.001），表明神经吻合的 DIEP 皮瓣乳房感觉恢复明显优于非神经吻合的 DIEP 皮瓣。在每个月的随访中，神经吻合的皮瓣平均单丝值下降 0.083（p<0.001），而非神经吻合的皮瓣下降 0.012（p<0.001）。神经吻合在即刻和延迟重建中均显著改善了感觉。
本研究表明，DIEP 皮瓣乳房重建中的神经吻合与非神经吻合皮瓣相比，可显著改善重建乳房各部位的感觉恢复。随访时间与感觉恢复显著相关。
