Leskovar Jana, Petrovečki Marko, Bulić Krešimir
University of Zagreb School of Medicine, Zagreb, Croatia.
Department of Radiology, University Hospital Centre Zagreb, Zagreb, Croatia.
Innov Surg Sci. 2024 Jul 24;10(2):81-89. doi: 10.1515/iss-2023-0070. eCollection 2025 Jun.
Breast sensation following autologous breast reconstruction impacts patients' quality of life. Although spontaneous reinnervation in free flaps was documented by many authors, there are efforts to further improve restoration of breast sensation. Interestingly, animal studies indicated that trastuzumab has several beneficial effects on transected peripheral nerves. Our aim was to compare spontaneous sensory recovery after free TRAM flap breast reconstruction between patients who were and were not treated with trastuzumab.
The study included 14 subjects who underwent tactile sensation examination in 5-year period after noninnervated free muscle-sparing TRAM flap breast reconstruction at the University Hospital Centre Zagreb, Croatia. Small and large flap skin islands and contralateral healthy breasts were tested with Semmes-Weinstein type monofilaments. Three sensory scores were created to more accurately compare breast sensation.
In subjects receiving trastuzumab, sensory recovery earlier extended to at least four of five large skin island regions and was always present in the central flap area in comparison with subjects who were not administered trastuzumab (p=0.0476). As indicated by total sensory scores, trastuzumab-treated subjects restored sensation better resembling healthy control breasts (54 vs. 39 % in large skin islands; 95 vs. 71 % in small skin islands).
To the authors' knowledge, the current study for the first time demonstrated trastuzumab's potential to improve sensory outcomes in human. Our results support the strategy that accelerated nerve regeneration is a key to more successful reinnervation. HER2 and EGFR inhibitors emerge as new candidates for pharmacological interventions in peripheral nerve injury treatment.
自体乳房重建后的乳房感觉会影响患者的生活质量。尽管许多作者都记录了游离皮瓣中的自发神经再支配情况，但仍在努力进一步改善乳房感觉的恢复。有趣的是，动物研究表明曲妥珠单抗对横断的周围神经有多种有益作用。我们的目的是比较接受和未接受曲妥珠单抗治疗的患者在游离腹直肌肌皮瓣乳房重建后自发感觉恢复的情况。
该研究纳入了14名在克罗地亚萨格勒布大学医院中心接受非神经支配的保留肌肉游离腹直肌肌皮瓣乳房重建术后5年内接受触觉感觉检查的受试者。使用Semmes-Weinstein型单丝对大小皮瓣皮岛和对侧健康乳房进行测试。创建了三个感觉评分以更准确地比较乳房感觉。
与未接受曲妥珠单抗治疗的受试者相比，接受曲妥珠单抗治疗的受试者的感觉恢复更早扩展到至少五个大皮岛区域中的四个，并且始终存在于皮瓣中央区域（p = 0.0476）。根据总感觉评分，接受曲妥珠单抗治疗的受试者感觉恢复情况更接近健康对照乳房（大皮岛中分别为54%对39%；小皮岛中分别为95%对71%）。
据作者所知，当前研究首次证明了曲妥珠单抗在改善人体感觉结果方面的潜力。我们的结果支持加速神经再生是更成功的神经再支配的关键这一策略。HER2和EGFR抑制剂成为周围神经损伤治疗中药理学干预的新候选药物。
