Sensory Recovery in the Sensate Free Transverse Rectus Abdominis Myocutaneous Flap

Yap, Lok Huei; Whiten, S; Förster, A.; Stevenson, Howard

doi:10.1097/01.prs.0000156988.78391.d6

Cited by 56 publications

(50 citation statements)

References 23 publications

(25 reference statements)

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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: 96%

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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Section: Clinical Applicationsmentioning

confidence: 96%

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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“…80 Sensation of free TRAM and DIEP flaps can be improved by coaptation of recipient cutaneous intercostal nerve branches to a single thoracoabdominal nerve in the flap. 81,82 The DIEP flap is usually raised on only one or two perforators, potentially making this flap more prone to fat necrosis than free TRAM flaps of comparable size. 70 Extra caution should be taken when harvesting large flaps (i.e., Ͼ400 g), especially in diabetic or smoking patients.…”

Section: Free Diep Flapmentioning

confidence: 99%

MOC-PSSM CME Article: Breast Reconstruction

Sigurdson

Lalonde

2008

Plastic and Reconstructive Surgery

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“…Reinnervation pilot studies have demonstrated recovery of sensation in immediate breast reconstruction with the latissimus flap [61], TRAM flaps [59], and perforator flaps [60]. The reinnervation techniques show different recovery patterns than those seen in nonreinnervated flaps, specifically with respect to temperature and fine touch, which may offer an element of protection to patients [59]. Larger prospective studies still need to be done to justify these procedures and further define the sensory innervation.…”

Section: Emerging Therapiesmentioning

confidence: 95%

“…• Mastectomy sacrifices sensory nerves to the breast, causing loss of sensation of the reconstructed breast mound. Despite reports of spontaneous return of sensation over time, several authors have advocated nerve repair at the time of breast reconstruction, to increase the quality and quantity of flap sensation [59,60]. Reinnervation pilot studies have demonstrated recovery of sensation in immediate breast reconstruction with the latissimus flap [61], TRAM flaps [59], and perforator flaps [60].…”

Section: Emerging Therapiesmentioning

confidence: 98%

“…Despite reports of spontaneous return of sensation over time, several authors have advocated nerve repair at the time of breast reconstruction, to increase the quality and quantity of flap sensation [59,60]. Reinnervation pilot studies have demonstrated recovery of sensation in immediate breast reconstruction with the latissimus flap [61], TRAM flaps [59], and perforator flaps [60]. The reinnervation techniques show different recovery patterns than those seen in nonreinnervated flaps, specifically with respect to temperature and fine touch, which may offer an element of protection to patients [59].…”

Section: Emerging Therapiesmentioning

confidence: 99%

See 1 more Smart Citation

Issues related to choice of breast reconstruction in early-stage breast cancer

O’Shaughnessy¹,

Fine²

2006

Curr. Treat. Options in Oncol.

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Reconstructive surgeons focus their efforts on refining and developing techniques that optimize oncologic outcome and recreate the most natural breast mound possible. The introduction of perforator flaps offers the potential for faster and more complete recovery, while increasing technical complexity and the risks associated with microsurgical reconstruction. Despite appealing long-lasting results, autologous reconstruction is not the ideal reconstructive choice for every patient. Tissue/expander reconstruction can produce a satisfactory aesthetic outcome and is the reconstruction of choice for most women undergoing breast reconstruction. Immediate autologous reconstruction at the time of mastectomy best resembles the lost breast and favorably withstands radiation, compared with other reconstructive methods. However, the best method for integrating reconstruction and radiation is being actively debated. Placing a tissue expander at the time of mastectomy allows a skin-sparing approach and gives the patient a chance to see how she will feel with an implant. This approach avoids radiation damage to tissue reconstruction flaps, saving them for use later if necessary. This approach, using a tissue expander as a first step, is growing in popularity.

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Sensory Recovery in the Sensate Free Transverse Rectus Abdominis Myocutaneous Flap

Cited by 56 publications

References 23 publications

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

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

MOC-PSSM CME Article: Breast Reconstruction

Issues related to choice of breast reconstruction in early-stage breast cancer

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