A new approach to microneurovascular TRAM-flap breast reconstruction--a pilot study.
BACKGROUND
The aims of the present study were to investigate whether microneurovascular breast reconstruction with a free transverse rectus abdominis musculocutaneous (TRAM) flap and nerve repair with nerves other than ThIV and ThXI improve sensory recovery of the breast compared to traditional free TRAM flap without nerve repair, and which nerve is optimal for the neural anastomosis of the flap.


METHODS
Twenty breast cancer patients underwent breast reconstruction with a free TRAM flap and nerve repair (neuro-TRAM) with the best available nerve from the axillary area and 20 control patients had traditional free TRAM flap without nerve repair (standard-TRAM). Neurorrhaphy was done by end-to-end or end-to-side techniques. Sensory and quantitative sensory testings (QST) were performed. Patient satisfaction was evaluated by a clinical questionnaire. The results were analysed by Mann-Whitney tests.


RESULTS
Mean follow-up was 32 months for the neuro-TRAM, and 54 months for the standard-TRAM group. Sensory outcome was better in the neuro-TRAM group (sensory score 45% of that of the contralateral breast) than in the standard-TRAM group (26% of the contralateral side). The median (quartiles) of total scores in the operated breasts was 12.9 (9.5-19.2) in neuro-TRAM group and 8.1 (3.5-10.7) in standard-TRAM group (Mann-Whitney Test (p=0.006)). All nerves available in the thoracic and axillary areas and both of the anastomosis techniques were successful in the reinnervation procedure. Nerve repair did not influence overall patient satisfaction.


CONCLUSIONS
This study indicates that any nerve repair results in improved sensory recovery after TRAM flap breast reconstruction. Any nerve available for anastomosis in the recipient site is potentially able to provide moderately good cutaneous sensibility to the TRAM-breast.
Puonti
Helena K
HK
Department of Surgery, Savonlinna Central Hospital, Finland. plastiikkakirurgia.helena@kolumbus.fi
Jääskeläinen
Satu K
SK
Hallikainen
Helena K
HK
Partanen
Taina A
TA
D000328:Adult; D001940:Breast / Q000098:blood supply / Q000294:innervation; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008866:Microsurgery; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D011183:Postoperative Complications; D017568:Rectus Abdominis / Q000098:blood supply / Q000637:transplantation*; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation*; D011795:Surveys and Questionnaires