Improved sensory recovery with a novel dual neurorrhaphy technique for breast reconstruction with free muscle sparing TRAM flap technique.
BACKGROUND
We describe a new dual neurorrhaphy method for a free abdominal-based flap and compare sensory recovery with this novel technique to that with conventional neurorrhaphy technique for breast reconstruction.


METHODS
70 breast cancer patients underwent muscle sparing innervated transversal rectus abdominis myocutaneous flap (neuro ms-TRAM) breast reconstruction with either a novel dual neurorrhaphy technique (N = 41) or single (N = 29) neurorrhaphy only. Dual neurorrhaphy was performed on both sides and single neurorrhaphy on one side of the flap, using the end-to-end or end-to-side technique. Two years postoperatively, quantitative sensory testing (QST) was performed for tactile, and thermal sensory modalities, and other tests included sharp-blunt, vibration, and two-point discrimination. Sensory modalities were scored either zero (abnormal) or one point (normal) at each test site against normal reference values (five sites for most tests). The total sensory scores (TSC) were calculated on the basis of the sums of the individual test scores, and all data are presented as the median (interquartile range, IQR).


RESULTS
The median of TSC in the breast reconstruction with the dual neurorrhaphy was higher (15.3, IQR 11.8-19.4), than that with the single neurorrhaphy (11.5, IQR 9.1-17.4) (P = 0.037). Regarding the different sensory modalities, the dual technique especially enhanced the tactile (P = 0.005) and cool detection (P = 0.021) recovery compared to the single neurorrhaphy.


CONCLUSIONS
Dual neurorrhaphy improved the sensory recovery of the reconstructed breast, and may therefore be recommended for clinical practice. © 2014 Wiley Periodicals, Inc. Microsurgery 37:21-28, 2017.
Department of Surgery, Savonlinna Central Hospital, Finland.
Helena K
HK
Puonti
Department of Clinical Neurophysiology, Turku University Hospital and University of Turku, Finland.
Satu K
SK
Jääskeläinen
Department of Surgery, Savonlinna Central Hospital, Finland.
Helena K
HK
Hallikainen
University of Helsinki, Finland.
Taina A
TA
Partanen
D000328:Adult; D001940:Breast / Q000294:innervation / Q000502:physiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000294:innervation / Q000637:transplantation*; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000294:innervation / Q000637:transplantation*; D012189:Retrospective Studies; D012677:Sensation