Momeni Arash, Meyer Shannon, Shefren Kerry, Januszyk Michael
Division of Plastic and Reconstructive Surgery, Stanford University School of Medicine, Palo Alto, Calif.
Plast Reconstr Surg Glob Open. 2021 Jan 12;9(1):e3328. doi: 10.1097/GOX.0000000000003328. eCollection 2021 Jan.
Autologous breast reconstruction is widely regarded as the gold standard approach following mastectomy. However, the lack of sensation continues to present a reconstructive challenge. In this study, clinical outcomes following abdominal flap neurotization with processed human nerve allograft were investigated.
In this prospective analysis, patients who underwent microsurgical breast reconstruction with (Group 1) or without (Group 2) abdominal flap neurotization at a single institution were investigated. Processed human nerve allograft (Avance, AxoGen, Alachua, Fla.) was used in all cases of flap neurotization. Only patients with a follow-up of ≥12 months were included. Cutaneous pressure threshold was tested using Semmes-Weinstein monofilaments (SWMF) at 9 pre-defined locations.
A total of 59 patients (96 breasts) were enrolled into the registry. Of these, 22 patients (Group 1: N = 15, 22 breasts; Group 2: N = 7, 14 breasts) had a complete data set with ≥12 months follow-up. Measuring cutaneous pressure thresholds, we observed a greater likelihood for return of protective sensation (SWMF ≤ 4.31) in neurotized breasts in 8 of the 9 examined zones. Additionally, flap neurotization was associated with a greater likelihood for return of protective sensation in the majority of the reconstructed breast-that is, ≥5 zones (55% versus 7%; < 0.01).
Flap neurotization using processed nerve allograft resulted in a greater degree of return of protective sensation to the reconstructed breast than reconstructions without neurotization at ≥12 months.
自体乳房重建被广泛认为是乳房切除术后的金标准方法。然而，感觉缺失仍然是一个重建方面的挑战。在本研究中，对采用处理过的人同种异体神经移植进行腹部皮瓣神经化后的临床结果进行了调查。
在这项前瞻性分析中，对在单一机构接受显微外科乳房重建且（第1组）或未（第2组）进行腹部皮瓣神经化的患者进行了调查。所有皮瓣神经化病例均使用处理过的人同种异体神经移植物（Avance，AxoGen，阿拉楚阿，佛罗里达州）。仅纳入随访时间≥12个月的患者。使用Semmes-Weinstein单丝（SWMF）在9个预先定义的位置测试皮肤压力阈值。
共有59例患者（96个乳房）被纳入登记。其中，22例患者（第1组：N = 15，22个乳房；第2组：N = 7，14个乳房）有完整数据集且随访时间≥12个月。在测量皮肤压力阈值时，我们观察到在9个检查区域中的8个区域，神经化乳房恢复保护性感觉（SWMF≤4.31）的可能性更大。此外，皮瓣神经化与大多数重建乳房（即≥5个区域）恢复保护性感觉的可能性更大相关（55%对7%；P<0.01）。
使用处理过的神经移植物进行皮瓣神经化，在≥12个月时，与未进行神经化的重建相比，重建乳房恢复保护性感觉的程度更高。
