title: Prevention of perioperative limb neuropathies in abdominal free flap breast reconstruction.
abstract: OBJECTIVE
  Perioperative peripheral neuropathies are a significant cause of post-operative morbidity in patients undergoing prolonged procedures. The aims of this study were to determine the incidence and possible causes of peripheral neuropathy in patients undergoing abdominal free flap breast reconstruction and to develop methods of ameliorating this problem.
  
  
  METHODS
  A 4-year retrospective study of patients undergoing abdominal free flap breast reconstruction by a single surgeon and anaesthetist was undertaken to determine the incidence and potential causes of perioperative neuropathy. A new positioning protocol was introduced to minimise the stretch on the brachial plexus and to protect peripheral nerves from compression forces. In addition, regular intraoperative physiotherapy was introduced. A prospective study was then conducted on patients managed by the same team to evaluate the effect of this change in practice on the subsequent incidence of peripheral neuropathies.
  
  
  RESULTS
  Over the 4-year retrospective period, 93 consecutive patients underwent abdominal free flap breast reconstruction, six of whom (6.5%) developed a peripheral neuropathy. Following the introduction of the new positioning protocol, prospective data collected on 65 consecutive patients showed no further occurrences of perioperative neuropathy (p = 0.04). There were no significant differences in the characteristics between the two cohorts.
  
  
  CONCLUSIONS
  Perioperative peripheral neuropathy in abdominal free flap breast reconstruction is a preventable problem. This paper presents a peripheral neuropathy prevention protocol for managing these patients.
authors.affiliation: Department of Plastic Surgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom.
authors.forename: Adam
authors.initials: A
authors.lastname: Blackburn
authors.affiliation: Department of Plastic Surgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom.
authors.forename: Rieka
authors.initials: R
authors.lastname: Taghizadeh
authors.affiliation: Department of Anaesthesia, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Hughes
authors.affiliation: Department of Plastic Surgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom. Electronic address: joe.o'donoghue@nuth.nhs.uk.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: O'Donoghue
mesh_terms: D000009:Abdominal Muscles / Q000637:transplantation*; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005121:Extremities; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D056888:Patient Positioning / Q000009:adverse effects*; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D057234:Preoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: Breast reconstruction; Free flaps; Microsurgery; Neuropathy