Jordan Chloe, Sosnowski Krzysztof, Shah Rushabh, Wong Kai Yuen, Benyon Sarah, Irwin Michael, Malata Charles
Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge United Kingdom.
School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, United Kingdom.
JPRAS Open. 2025 Jun 14;45:225-229. doi: 10.1016/j.jpra.2025.06.006. eCollection 2025 Sep.
Symptomatic animation deformity (AD) following latissimus dorsi (LD) flap breast reconstruction, though uncommon, significantly impacts patient satisfaction. Primary denervation is typically avoided due to potential intraoperative risk of damage to the LD vascular pedicle and subsequent muscle atrophy, which may necessitate future fat grafting. This study evaluates the incidence of troublesome AD requiring surgical intervention and assesses the safety and efficacy of selective delayed denervation in symptomatic patients at a UK university hospital.
Patients who underwent LD flap breast reconstruction between January 2014 and December 2024 were retrospectively analysed. Those with troublesome AD who subsequently underwent delayed denervation were identified. Data on demographics, surgical details, and outcomes were collected to evaluate the effectiveness and safety of delayed thoracodorsal nerve denervation.
Among 90 LD flaps in 84 patients (78 unilateral, 6 bilateral, mean age = 53.6 years, BMI = 25.8), 8.3 % ( = 7) reported troublesome AD, with almost half ( = 3) also experiencing pain. Delayed denervation was performed in all seven, with symptom improvement in six: complete resolution in 57.1 % ( = 4), partial relief in 28.7 % ( = 2), whilst one patient required redo surgery. No complications (e.g., infection, muscle atrophy, implant loss, rippling or long thoracic nerve damage) were reported.
Our findings demonstrate that selective delayed thoracodorsal nerve denervation effectively manages symptomatic AD while avoiding overtreatment in asymptomatic patients. This approach preserves muscle volume, unlike primary denervation, and achieves a high success rate with minimal morbidity. Future prospective studies are required to establish standardised assessment criteria and optimal timing for intervention.
背阔肌（LD）皮瓣乳房重建术后出现症状性动态畸形（AD），虽不常见，但会显著影响患者满意度。由于术中存在损伤LD血管蒂及随后肌肉萎缩的潜在风险，通常避免进行初次去神经支配，而这可能需要未来进行脂肪移植。本研究评估了需要手术干预的麻烦AD的发生率，并评估了在英国一家大学医院对有症状患者进行选择性延迟去神经支配的安全性和有效性。
对2014年1月至2024年12月期间接受LD皮瓣乳房重建的患者进行回顾性分析。确定那些随后接受延迟去神经支配的麻烦AD患者。收集人口统计学、手术细节和结果数据，以评估延迟胸背神经去神经支配的有效性和安全性。
在84例患者的90个LD皮瓣中（78例单侧，6例双侧，平均年龄 = 53.6岁，BMI = 25.8），8.3%（n = 7）报告有麻烦AD，其中近一半（n = 3）也伴有疼痛。所有7例均进行了延迟去神经支配，6例症状改善：57.1%（n = 4）完全缓解，28.7%（n = 2）部分缓解，而1例患者需要再次手术。未报告并发症（如感染、肌肉萎缩、植入物丢失、波纹或胸长神经损伤）。
我们的研究结果表明，选择性延迟胸背神经去神经支配可有效治疗症状性AD，同时避免对无症状患者进行过度治疗。与初次去神经支配不同，这种方法保留了肌肉体积，并以最小的发病率取得了高成功率。未来需要进行前瞻性研究以建立标准化的评估标准和最佳干预时机。
