Sensory recovery following free TRAM flap breast reconstruction

Liew, S. C. C.; Hunt, Jeremy; Pennington, David

doi:10.1016/s0007-1226(96)90052-1

Cited by 73 publications

(54 citation statements)

References 13 publications

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“…Two measured pressure thresholds within the skin island of TRAM flaps [3,5]. As we have shown, both Slezak et al [3] and Liew et al [5] found the best sensory recovery for constant touch in the inferomedial part of the flap. Other investigators included the whole [6].…”

Section: Discussionmentioning

confidence: 66%

Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction

Tindholdt

Tønseth

2008

Scandinavian Journal of Plastic and Reconstructive Surgery and

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The deep inferior epigastric artery perforator (DIEAP) flap is the gold standard of free flaps in breast reconstruction. However, until now little attention has been paid to reinnervation of the flap. The aim of this study was to examine the spontaneous reinnervation of the DIEAP flap after breast reconstruction. The study was cross-sectional, and included 29 women who had all previously had secondary reconstruction with a DIEAP flap after mastectomy for breast cancer. Pressure thresholds were analysed on the skin island of the flap using Semmes-Weinstein monofilaments. The measurements showed measurable sensation in 29 of the 30 flaps. Nine patients had normal or diminished light touch in one or more areas. We also found significant better pressure sensitivity when the medial was compared to the lateral side and the inferior to the superior side of the flap. Our data showed that DIEAP flaps reinnervate after breast reconstruction although there is no sensory nerve repair. We suggest that nerve ingrowth takes place from the sides and this seems to be more pronounced in the inferomedial part of the flap.

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Section: Discussionmentioning

confidence: 66%

Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction

Tindholdt

Tønseth

2008

Scandinavian Journal of Plastic and Reconstructive Surgery and

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“…[1][2][3]15 In addition, we were able to construct color maps of fine-pressure sensation for each patient, which we have referred to as sensory topograms. They differ from previous methods of recording fine-pressure thresholds in that they show not only the contour of areas for each level of sensation on the SemmesWeinstein scale but also demonstrate the density of sensory recovery attained, as each color point on the map marks an area where the patient was able to feel the respective filament applied.…”

Section: Discussionmentioning

confidence: 99%

“…There have been studies documenting spontaneous recovery of sensation in reconstructed breasts, but this recovery was variable and unpredictable. 1,2 Slezak et al reported the first attempt to neurotize a rectus abdominis myocutaneous (TRAM) flap reconstruction, by coaptation of a lateral thoracic nerve branch to a thoracoabdominal nerve. 3 Sensory recovery has been reported in innervated pedicled TRAM flaps 4 and in innervated and noninnervated free deep inferior epigastric perforator (DIEP) flaps.…”

mentioning

confidence: 99%

Sensory Recovery in the Sensate Free Transverse Rectus Abdominis Myocutaneous Flap

Yap

Whiten

Förster

et al. 2005

Plastic and Reconstructive Surgery

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“…Since the first description of reinnervation of the abdominal wall flap by coapting the sensory innervation to the flap with a branch of the fourth intercostal nerve (Slezak et al, 1992), the clinical efficacy of the technique has been confirmed, but the anatomical basis has been disputed, particularly the segmental origins of the donor-site nerves (Allen and Treece, 1994;Liew et al, 1996;Blondeel et al, 1999;Yap et al, 2005;Temple et al, 2006).…”

Section: Clinical Applicationsmentioning

confidence: 99%

Refining the course of the thoracolumbar nerves: A new understanding of the innervation of the anterior abdominal wall

et al. 2008

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Previous descriptions of the thoracolumbar spinal nerves innervating the anterior abdominal wall have been inconsistent. With modern surgical and anesthetic techniques that involve or may damage these nerves, an improved understanding of the precise course and variability of this anatomy has become increasingly important. The course of the nerves of the anterior abdominal is described based on a thorough cadaveric study and review of the literature. Twenty human cadaveric hemi-abdominal walls were dissected to map the course of the nerves of the anterior abdominal wall. Dissection included a comprehensive tracing of nerves and their branches from their origins in five specimens. The branching pattern and course of all nerves identified were described. All thoracolumbar nerves that innervate the anterior abdominal wall were found to travel as multiple mixed segmental nerves, which branch and communicate widely within the transversus abdominis plane (TAP). This communication may occur at multiple locations, including large branch communications anterolaterally (intercostal plexus), and in plexuses that run with the deep circumflex iliac artery (DCIA) (TAP plexus) and the deep inferior epigastric artery (DIEA) (rectus sheath plexus). Rectus abdominis muscle is innervated by segments T6-L1, with a constant branch from L1. The umbilicus is always innervated by a branch of T10. As such, identification or damage to individual nerves in the TAP or within rectus sheath is unlikely to involve single segmental nerves. An understanding of this anatomy may contribute to explaining clinical outcomes and preventing complications, following TAP blocks for anesthesia and DIEA perforator flaps for breast reconstruction.

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Sensory recovery following free TRAM flap breast reconstruction

Cited by 73 publications

References 13 publications

Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction

Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction

Sensory Recovery in the Sensate Free Transverse Rectus Abdominis Myocutaneous Flap

Refining the course of the thoracolumbar nerves: A new understanding of the innervation of the anterior abdominal wall

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