Aristizábal Alejandra, Herrera Harrison, Escandón Joseph M, Ciudad Pedro, Del Corral Gabriel, Nazerali Rahim, Mascaro Andres, Manrique Oscar J
Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA.
School of Medicine, Universidad Surcolombiana, Neiva, Colombia.
Microsurgery. 2025 Jul;45(5):e70096. doi: 10.1002/micr.70096.
Tactile sensory recovery in autologous breast reconstruction (ABR) has been shown to prevent injuries and improve quality of life. However, the studies comparing neurotized versus non-neurotized outcomes are still controversial due to methodological heterogeneity. This review uses consistent and objective outcomes to evaluate the current evidence's qualitative characteristics and quantitative tactile sensory recovery.
We conducted a systematic electronic literature search from database inception through 10 February 2024, of the following databases: PubMed, Ovid MEDLINE, Embase, SCOPUS, and CINAHL to identify all studies reporting outcomes of tactile sensory recovery using the Semmes-Weinstein Measuring scale in free-flap ABR comparing neurotization versus non-neurotization. The SWM scale score, demographic characteristics, and surgical features were extracted from each study. Due to the data heterogeneity within the studies, we transformed the data into means and pooled the qualitative information.
We identified 264 articles. After thorough screening, 12 fulfilled the inclusion criteria and were included in the qualitative synthesis. Finally, 7 were quantitatively analyzed with a total of 251 breasts that underwent ABR with free flap neurotization and 244 breasts without neurotization. This revealed a mean SWM score difference of -0.67 and a significant p-value < 0.05. A subgroup DIEP flap analysis performed for 177 neurotized compared to 175 non-eurotized flaps yielded a significant mean difference of -0.86 p < 0.05. There were no significant differences between groups in age (48.8 vs. 49.8, p = 0.5), history of chemotherapy (72 vs. 74, p = 0.91), radiotherapy (61 vs. 56, p = 0.84), or follow-up time (21.85 vs. 25.09 months, p = < 0.05) that could have influenced tactile sensory recovery.
Neurotization in free-flap ABR could allow better tactile sensory recovery than the spontaneous sensation gained without it. The additional surgical time required for coaptation is short, and no studies have reported associated complications, making it a safe procedure that can potentially improve patients´ quality of life. Nonetheless, higher-quality studies, such as randomized control trials with standardized sensation testing and more rigorous methodologies, are needed before making final clinical recommendations.
自体乳房重建（ABR）中的触觉感觉恢复已被证明可预防损伤并改善生活质量。然而，由于方法学的异质性，比较神经化与非神经化结果的研究仍存在争议。本综述使用一致且客观的结果来评估当前证据的定性特征和定量触觉感觉恢复情况。
我们从数据库建立至2024年2月10日进行了系统的电子文献检索，检索了以下数据库：PubMed、Ovid MEDLINE、Embase、SCOPUS和CINAHL，以识别所有使用Semmes-Weinstein测量量表报告游离皮瓣ABR中触觉感觉恢复结果的研究，比较神经化与非神经化情况。从每项研究中提取SWM量表评分、人口统计学特征和手术特征。由于研究中的数据异质性，我们将数据转换为均值并汇总定性信息。
我们识别出264篇文章。经过全面筛选，12篇符合纳入标准并被纳入定性综合分析。最后，对7项研究进行了定量分析，共有251例接受游离皮瓣神经化ABR的乳房和244例未进行神经化的乳房。这显示平均SWM评分差异为-0.67，p值<0.05具有统计学意义。对177例神经化皮瓣与175例非神经化皮瓣进行的DIEP皮瓣亚组分析显示平均差异为-0.86，p<0.05具有统计学意义。两组在年龄（48.8对49.8，p=0.5）、化疗史（72对74，p=0.91）、放疗史（61对56，p=0.84）或随访时间（21.85对25.09个月，p=<0.05）方面没有显著差异，这些因素本可能影响触觉感觉恢复。
游离皮瓣ABR中的神经化可能比未进行神经化时获得的自发感觉能实现更好的触觉感觉恢复。吻合所需的额外手术时间很短，且没有研究报告相关并发症，这使其成为一种安全的手术方法，有可能改善患者的生活质量。尽管如此，在做出最终临床建议之前，还需要更高质量的研究，如采用标准化感觉测试和更严格方法的随机对照试验。
