Neoplasms

Skin and Connective Tissue Diseases

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Breast Neoplasms

Patients in this group underwent immediate or delayed, unilateral or bilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction with additional sensory nerve coaptation.

Patients in this group underwent immediate or delayed, unilateral or bilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction without sensory nerve coaptation.

A recipient sensory nerve of the abdomen was reattached to a donor nerve in the chest area. The sensory branch of usually the 11th intercostal nerve was used as recipient nerve for nerve coaptation and the anterior cutaneous branch of the third intercostal nerve was used as donor nerve. Direct, end-to-end nerve coaptation was performed with two stitches.

Sensory nerve coaptation

René van der Hulst, MD, PhD

The sensory recovery of the breast remains an undervalued aspect of breast reconstruction and surgical reinnervation is not regarded as a priority by most reconstructive surgeons. A prospective study was conducted of all patients who underwent either innervated or non-innervated DIEP flap breast reconstruction in Maastricht University Medical Center and returned for follow-up between September 2015 and July 2017. Semmes-Weinstein monofilaments were used for sensory testing of the breast. This study showed that nerve coaptation in DIEP flap breast reconstruction resulted in a significantly improved sensation of the reconstructed breast compared to non-innervated flaps.

Nerve Coaptation in DIEP Flap Breast Reconstruction

Sensory Recovery of the Breast Following Innervated and Non-innervated DIEP Flap Breast Reconstructions

The sensory recovery of the breast to touch was tested at different follow-up moments after the initial surgery. Semmes-Weinstein monofilaments were used for sensory testing. Nine areas of the breast, indicating native skin and flap skin, were tested. Mean monofilament values were calculated for each area and compared between groups.

Maastricht University Medical Center

Prof. Dr.

Patients in this group underwent immediate or delayed, unilateral or bilateral lateral thigh perforator (LTP) flap breast reconstruction with additional sensory nerve coaptation.

Patients in this group underwent immediate or delayed, unilateral or bilateral lateral thigh perforator (LTP) flap breast reconstruction without sensory nerve coaptation.

A recipient sensory nerve branch of the lateral cutaneous femoral nerve (LCFN) was reattached to a donor nerve in the chest area. The anterior cutaneous branch of the second or third intercostal nerve was used as the donor nerve. Direct, end-to-end nerve coaptation was performed.

The sensory recovery of the breast remains an undervalued aspect of breast reconstruction and surgical reinnervation is not regarded as a priority by most reconstructive surgeons. A prospective study was conducted of all patients who underwent either innervated or non-innervated lateral thigh perforator (LTP) flap breast reconstruction in Maastricht University Medical Center and returned for follow-up between February 2016 and April 2019. Semmes-Weinstein monofilaments were used for sensory testing of the breast.

Nerve Coaptation in LTP Flap Breast Reconstruction

Sensory Recovery of the Breast Following Innervated and Non-innervated Lateral Thigh Perforator (LTP) Flap Breast Reconstructions

Head of the Plastic Surgery department

Patients in this group underwent immediate or delayed, unilateral or bilateral DIEP flap breast reconstruction with additional sensory nerve coaptation.

Patients in this group underwent immediate or delayed, unilateral or bilateral DIEP flap breast reconstruction without sensory nerve coaptation.

A recipient sensory nerve branch of the 11th-12th intercostal nerve was reattached to a donor nerve in the chest area. The anterior cutaneous branch of the second or third intercostal nerve was used as the donor nerve. Direct, end-to-end nerve coaptation was performed.

Restoring the sensation of the breast becomes increasingly recognized as a critical part of autologous breast reconstruction. A prospective study was conducted of all patients who underwent either innervated or non-innervated deep inferior epigastric perforator (DIEP) flap breast reconstruction in Maastricht University Medical Center between August 2016 and August 2018 and who returned between for a follow-up visit between the start of the study and August 2019. Semmes-Weinstein monofilaments were used for sensory testing of the breast.

Sensory Nerve Coaptation in DIEP Flap Breast Reconstruction

Nerve Coaptation Improves the Sensory Recovery of the Breast in DIEP Flap Breast Reconstruction

The sensory recovery of the donor site to touch was tested at different follow-up moments after the initial surgery. Semmes-Weinstein monofilaments were used for sensory testing. Four areas of the donor site were tested, two areas above and two areas below the scar. Mean monofilament values were calculated for the total donor site and compared between groups.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Nerve Coaptation in DIEP Flap Breast Reconstruction	NCT03428789	Breast Cancer	Sensory nerve c...	18 Years -	Maastricht University Medical Center
Nerve Coaptation in LTP Flap Breast Reconstruction	NCT03959943	Breast Cancer	Sensory nerve c...	18 Years - 80 Years	Maastricht University Medical Center
Nerve Coaptation in DIEP Flap Breast Reconstruction	NCT03428789	Breast Cancer	Sensory nerve c...	18 Years -	Maastricht University Medical Center
Sensory Nerve Coaptation in DIEP Flap Breast Reconstruction	NCT04093999	Breast Cancer	Sensory nerve c...	18 Years -	Maastricht University Medical Center
Nerve Coaptation in LTP Flap Breast Reconstruction	NCT03959943	Breast Cancer	Sensory nerve c...	18 Years - 80 Years	Maastricht University Medical Center
Sensory Nerve Coaptation in DIEP Flap Breast Reconstruction	NCT04093999	Breast Cancer	Sensory nerve c...	18 Years -	Maastricht University Medical Center
Nerve Coaptation in DIEP Flap Breast Reconstruction	NCT03428789	Breast Cancer	Sensory nerve c...	18 Years -	Maastricht University Medical Center

Spots Global Cancer Trial Database for sensory nerve coaptation