title: Breast Reinnervation: DIEP Neurotization Using the Third Anterior Intercostal Nerve.
abstract: BACKGROUND
  The purpose of this article is to evaluate a new method of DIEP flap neurotization using a reliably located recipient nerve. We hypothesize that neurotization by this method (with either nerve conduit or direct nerve coaptation) will have a positive effect on sensory recovery.
  
  
  METHODS
  Fifty-seven deep inferior epigastric perforator (DIEP) flaps were performed on 35 patients. Neurotizations were performed to the third anterior intercostal nerve by directly coapting the flap donor nerve or coapting with a nerve conduit. Nine nonneurotized DIEP flaps served as controls and received no attempted neurotization. All patients were tested for breast sensibility in 9 areas of the flap skin-island and adjacent postmastectomy skin. Testing occurred at an average of 111 weeks (23-309) postoperatively.
  
  
  RESULTS
  At a mean of 111 weeks after breast reconstruction, neurotization of the DIEP flap resulted in recovery of sensibility that was statistically significantly better (lower threshold) in the flap skin (P < 0.01) and statistically significantly better than in the native mastectomy skin into which the DIEP flap was inserted (P < 0.01). Sensibility recovered in DIEP flaps neurotized using the nerve conduit was significantly better (lower threshold) than that in the corresponding areas of the DIEP flaps neurotized by direct coaptation (P < 0.01).
  
  
  CONCLUSIONS
  DIEP flap neurotization using the third anterior intercostal nerve is an effective technique to provide a significant increase in sensory recovery for breast reconstruction patients, while adding minimal surgical time. Additionally, the use of a nerve conduit produces increased sensory recovery when compared direct coaptation.
authors.affiliation: Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex.; Department of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Tex.; Departments of Plastic and Reconstructive Surgery and Neurology and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Md; and Dellon Institute for Peripheral Nerve Surgery, Towson, Md.
authors.forename: Aldona J
authors.initials: AJ
authors.lastname: Spiegel
authors.affiliation: Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex.; Department of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Tex.; Departments of Plastic and Reconstructive Surgery and Neurology and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Md; and Dellon Institute for Peripheral Nerve Surgery, Towson, Md.
authors.forename: Zachary K
authors.initials: ZK
authors.lastname: Menn
authors.affiliation: Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex.; Department of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Tex.; Departments of Plastic and Reconstructive Surgery and Neurology and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Md; and Dellon Institute for Peripheral Nerve Surgery, Towson, Md.
authors.forename: Liron
authors.initials: L
authors.lastname: Eldor
authors.affiliation: Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex.; Department of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Tex.; Departments of Plastic and Reconstructive Surgery and Neurology and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Md; and Dellon Institute for Peripheral Nerve Surgery, Towson, Md.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Kaufman
authors.affiliation: Institute for Reconstructive Surgery, Houston Methodist Hospital, Houston, Tex.; Department of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Tex.; Departments of Plastic and Reconstructive Surgery and Neurology and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Md; and Dellon Institute for Peripheral Nerve Surgery, Towson, Md.
authors.forename: A Lee
authors.initials: AL
authors.lastname: Dellon