title: Sensibility following innervated free TRAM flap for breast reconstruction: Part II. Innervation improves patient-rated quality of life.
abstract: BACKGROUND
  Restoring sensory innervation may be a useful adjunct in free flap head and neck reconstruction but, as yet, has not been shown to improve outcomes of breast reconstruction. The authors' previous study demonstrated objectively improved sensation in a group of innervated transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction patients relative to noninnervated flaps. This study compared patient-rated outcomes of free TRAM breast reconstruction in innervated versus noninnervated flaps.
  
  
  METHODS
  Twenty-seven women were randomized prospectively to undergo either innervated or noninnervated free TRAM flap breast reconstruction. For innervated flaps, the T10 intercostal nerve was harvested with the TRAM flap and neurotized to the T4 sensory nerve at the recipient site. Three validated outcome tools were administered after surgery: the Medical Outcomes Study 36-Item Short Form Health Survey, the Body Image after Breast Cancer Questionnaire, and the Functional Assessment of Cancer Therapy-Breast. Results were correlated with previously reported objective sensibility outcomes.
  
  
  RESULTS
  Eighteen of 27 women returned their questionnaires a mean 48 months after free TRAM flap reconstruction. Demographic analysis revealed no significant differences in patient age, height, smoking, radiation therapy, and nipple-areola complex reconstruction between randomized patient groups. There was a statistically significant improvement in all three measures in patients who were randomized to receive innervated free TRAM flaps compared with those receiving noninnervated flaps.
  
  
  CONCLUSIONS
  This study demonstrates that innervation of free TRAM flaps used for breast reconstruction not only improves sensibility but also has a positive effect on patient-rated quality of life.
authors.affiliation: London, Ontario, Canada From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Lawson Health Research Institute, University of Western Ontario.
authors.forename: Claire L F
authors.initials: CLF
authors.lastname: Temple
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Ross
authors.forename: Sharon
authors.initials: S
authors.lastname: Kim
authors.forename: Raymond
authors.initials: R
authors.lastname: Tse
authors.forename: Margo
authors.initials: M
authors.lastname: Bettger-Hahn
authors.forename: Bing Siang
authors.initials: BS
authors.lastname: Gan
authors.forename: Joy
authors.initials: J
authors.lastname: MacDermid
mesh_terms: D000328:Adult; D000368:Aged; D001828:Body Image; D001943:Breast Neoplasms / Q000601:surgery*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015411:Mastectomy, Modified Radical; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D016067:Nerve Transfer / Q000379:methods; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D017568:Rectus Abdominis / Q000637:transplantation; D013524:Surgical Flaps / Q000294:innervation*; D011795:Surveys and Questionnaires; D014110:Touch; D016896:Treatment Outcome