title: No need to cut the nerve in LD reconstruction to avoid jumping of the breast: a prospective randomized study.
abstract: OBJECTIVE
  It has been shown that the myocutaneous latissimus dorsi flap volume and consistency remain mainly the same regardless the nerve is cut or not in breast reconstruction. It is controversial how big an impact the flap innervation has on the muscle activity of the flap. The aim of the study was to prospectively evaluate the influence of latissimus dorsi flap innervation on the functional and aesthetic outcome of delayed breast reconstruction.
  
  
  METHODS
  Between 2007 and 2008, 28 breast reconstructions were performed and randomly divided into denervation group (surgical denervation by excision of 1 cm of proximal thoracodorsal nerve, n=14) and innervation group (thoracodorsal nerve saved intact, n=14). Patients were clinically evaluated and a questionnaire considering functional and aesthetic outcome was filled 1-year after operation. Muscular twitching, pain, tightness, shape and symmetry of the breasts were evaluated. In addition, the mobility of the shoulder joint on the operated side was evaluated and the patients self-estimated the activities of daily living.
  
  
  RESULTS
  There was no significant difference in latissimus dorsi flap twitching, pain and tightness of the breast and symmetry and shape of the breasts between denervated and innervated groups. The shoulder joint mobility was not found to be changed significantly in either of the groups and there were no limitations in activities of daily living.
  
  
  CONCLUSIONS
  Thoracodorsal nerve division or preservation does not significantly affect muscle contraction activity of the latissimus dorsi flap and distortion of the breast when latissimus dorsi muscle humeral insertion is also detached. Therefore, both cutting and saving the nerve are justified in latissimus dorsi flap breast reconstruction depending on whether the humeral insertion of the muscle is preserved intact or divided and the flap islanded. The study shows that there is no tangible benefit in dividing the nerve when the flap is islanded. Clinical trial has been registered in public trials registry. Trial registry name is 'The significance of latissimus dorsi flap innervation in delayed breast reconstruction'. Registration number is NCT01239524 and URL is https://register.clinicaltrials.gov.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland. Electronic address: minna.t.kaariainen@gmail.com.
authors.forename: Minna
authors.initials: M
authors.lastname: Kääriäinen
authors.affiliation: Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Giordano
authors.affiliation: Department of Plastic and Reconstructive Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Kauhanen
authors.affiliation: Science Center, Pirkanmaa Hospital District and School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Helminen
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Kuokkanen
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003714:Denervation; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D011446:Prospective Studies; D012399:Rotation; D012785:Shoulder Joint / Q000502:physiology; D064171:Superficial Back Muscles / Q000637:transplantation*; D013524:Surgical Flaps / Q000294:innervation*
keywords: Breast reconstruction; Denervation; Flap; Innervation; Latissimus dorsi muscle; Muscle activity