title: Prospective computerized analyses of sensibility in breast reconstruction with non-reinnervated DIEP flap.
abstract: BACKGROUND
  The deep inferior epigastric perforator (DIEP) flap is considered the definitive standard for autologous breast reconstruction because of its ability to restore shape, its consistency, and its static and dynamic symmetry, but the degree of spontaneous sensory recovery is still widely discussed. To clarify the real need for sensitive nerve coaptation, return of sensibility in DIEP flaps was investigated using a pressure-specifying sensory device.
  
  
  METHODS
  Thirty consecutive patients with breast cancer scheduled for modified radical mastectomy, axillary node dissection, and immediate reconstruction with cutaneous-adipose DIEP flaps without nerve repair were enrolled in the study. Sensibility for one and two points, static and moving, was tested preoperatively on the breasts and abdomen, and postoperatively at 6 and 12 months on the DIEP flaps. A t test was used for comparison of paired data and to investigate which factors affected sensory recovery.
  
  
  RESULTS
  Preoperative healthy breast and abdomen pressure thresholds were lower for two-point than one-point discrimination and for moving discriminations compared with static ones at 6 and 12 months. Although they were significantly higher than those for contralateral healthy breasts (p < 0.05), pressure thresholds in DIEP flaps at 12 months were lower than at 6 months, showing a significant progressive sensory recovery (p < 0.05). At 12 months postoperatively, the best sensibility recovery was found at the inferior lateral quadrant, the worst at the superior medial quadrant. Age and flap weight were factors related to the performance of sensory recovery.
  
  
  CONCLUSIONS
  DIEP flap transfer for immediate breast reconstruction undergoes satisfactory progressive spontaneous sensitive recovery at 6 and 12 months after surgery, and operative time spent dissecting sensitive perforator branches and their coaptation in recipient site could be spared.
authors.affiliation: Rome, Italy From the Plastic Surgery Unit, Sant' Andrea Hospital, School of Medicine and Psychology, "Sapienza" University of Rome.
authors.forename: Fabio
authors.initials: F
authors.lastname: Santanelli
authors.forename: Benedetto
authors.initials: B
authors.lastname: Longo
authors.forename: Matteo
authors.initials: M
authors.lastname: Angelini
authors.forename: Rosaria
authors.initials: R
authors.lastname: Laporta
authors.forename: Guido
authors.initials: G
authors.lastname: Paolini
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000294:innervation*; D001943:Breast Neoplasms / Q000601:surgery; D001330:Electronic Data Processing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000706:statistics & numerical data; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D020127:Recovery of Function; D012677:Sensation / Q000502:physiology*; D013524:Surgical Flaps / Q000294:innervation*; D013997:Time Factors; D016896:Treatment Outcome