PDF(Pubmed)
Abstract：
BACKGROUND: Sensory nerve coaptation has great potential to restore sensation after autologous breast reconstruction. However, blinded and randomized studies are lacking. We therefore present the preliminary results of our ongoing double-blinded randomized controlled trial that compares sensory recovery of innervated versus non-innervated DIEP flaps.
METHODS: Patients who underwent DIEP flap breast reconstruction between July 2019 and February 2022 were included and randomized. The anterior cutaneous branch of the second or third intercostal nerve was coapted. Pre- and postoperative sensory testing was performed with Semmes-Weinstein Monofilaments, Pressure Specified Sensory Device, and a thermostimulator, for tactile and temperature thresholds.
RESULTS: This interim analysis comprised 41 patients contributing 29 innervated and 38 non-innervated breasts. At 24 months of follow-up, the mean monofilament value of the flap skin was lower in innervated than in non-innervated flaps (4.48 vs. 5.20, p = 0.003). Touch thresholds were lower the center of the innervated flaps (47.8 vs. 71.2 g/mm2, p = 0.036), and heat pain was more often imperceptible in non-innervated flaps (42.1% vs. 10.3%, p = 0.004). No adverse events were associated with sensory nerve coaptation.
CONCLUSIONS: These preliminary results indicate superior sensibility and recovery of protective sensation in innervated compared with non-innervated DIEP flaps. Although the results of the completed trial must be awaited to establish the full clinical impact, including highly anticipated quality of life outcomes, we encourage continuation of scientific and clinical efforts in this promising technique.
METHODS: Patients who underwent DIEP flap breast reconstruction between July 2019 and February 2022 were included and randomized. The anterior cutaneous branch of the second or third intercostal nerve was coapted. Pre- and postoperative sensory testing was performed with Semmes-Weinstein Monofilaments, Pressure Specified Sensory Device, and a thermostimulator, for tactile and temperature thresholds.
RESULTS: This interim analysis comprised 41 patients contributing 29 innervated and 38 non-innervated breasts. At 24 months of follow-up, the mean monofilament value of the flap skin was lower in innervated than in non-innervated flaps (4.48 vs. 5.20, p = 0.003). Touch thresholds were lower the center of the innervated flaps (47.8 vs. 71.2 g/mm2, p = 0.036), and heat pain was more often imperceptible in non-innervated flaps (42.1% vs. 10.3%, p = 0.004). No adverse events were associated with sensory nerve coaptation.
CONCLUSIONS: These preliminary results indicate superior sensibility and recovery of protective sensation in innervated compared with non-innervated DIEP flaps. Although the results of the completed trial must be awaited to establish the full clinical impact, including highly anticipated quality of life outcomes, we encourage continuation of scientific and clinical efforts in this promising technique.
摘要：
背景：感觉神经接合在自体乳房重建后恢复感觉方面具有巨大潜力。然而,缺乏盲法和随机研究.因此，我们提供了我们正在进行的双盲随机对照试验的初步结果，该试验比较了神经支配和非神经支配DIEP皮瓣的感觉恢复。
方法：纳入2019年7月至2022年2月接受DIEP皮瓣乳房再造的患者并进行随机分组。第二或第三肋间神经的前皮肤分支接合。使用Semmes-Weinstein单丝进行术前和术后感觉测试，压力指定的感觉装置,和一个热刺激器，触觉和温度阈值。
结果：本中期分析包括41名患者，其中29名受神经支配的乳房和38名非神经支配的乳房。在24个月的随访中，神经支配的皮瓣皮肤的平均单丝值低于非神经支配的皮瓣（4.48vs.5.20,p=0.003)。接触阈值降低了神经支配皮瓣的中心（47.8vs.71.2g/mm2,p=0.036),在非神经支配的皮瓣中，热痛更常见(42.1%vs.10.3%,p=0.004)。没有与感觉神经接合相关的不良事件。
结论：这些初步结果表明，与非神经支配的DIEP皮瓣相比，神经支配的DIEP皮瓣具有更好的敏感性和保护性感觉恢复。尽管必须等待完成的试验结果以确定完整的临床影响，包括高度预期的生活质量结果，我们鼓励在这项有前途的技术中继续进行科学和临床努力。
方法：纳入2019年7月至2022年2月接受DIEP皮瓣乳房再造的患者并进行随机分组。第二或第三肋间神经的前皮肤分支接合。使用Semmes-Weinstein单丝进行术前和术后感觉测试，压力指定的感觉装置,和一个热刺激器，触觉和温度阈值。
结果：本中期分析包括41名患者，其中29名受神经支配的乳房和38名非神经支配的乳房。在24个月的随访中，神经支配的皮瓣皮肤的平均单丝值低于非神经支配的皮瓣（4.48vs.5.20,p=0.003)。接触阈值降低了神经支配皮瓣的中心（47.8vs.71.2g/mm2,p=0.036),在非神经支配的皮瓣中，热痛更常见(42.1%vs.10.3%,p=0.004)。没有与感觉神经接合相关的不良事件。
结论：这些初步结果表明，与非神经支配的DIEP皮瓣相比，神经支配的DIEP皮瓣具有更好的敏感性和保护性感觉恢复。尽管必须等待完成的试验结果以确定完整的临床影响，包括高度预期的生活质量结果，我们鼓励在这项有前途的技术中继续进行科学和临床努力。
