Restoring Sensation through Abdominal Flap Neurotization in Breast Reconstruction
Abstract
1. Introduction
2. Background
3. Relevant Anatomy
4. Surgical Techniques
5. Outcomes
6. Future Directions
7. Conclusions
Funding
Conflicts of Interest
References
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Authors | Year | Technical Innovation | Advantages |
---|---|---|---|
Slezak et al. [14] | 1992 | Introduced the concept of TRAM flap neurotization (via coaptation of a long segment of abdominal ICN to the LCB of ICN 4) | Accelerates the return of sensation in TRAM flaps versus those that do not undergo surgical neurotization |
Spiegel et al. [38,55] | 2009, 2013 | Described utilizing the ACB (rather than the LCB) of ICN 3 as a recipient nerve | Confines all microsurgical connections to a single field, improving efficiency and flexibility of flap inset |
Used 40 mm hollow tube nerve conduits to bridge gaps between donor and recipient nerves | Enables nerve coaptation over the longer distances associated with using the ACB as a recipient; reportedly improves sensory recovery outcomes versus neurotization via direct coaptation | ||
Puonti et al. [33] | 2017 | Performed dual neurorrhaphy from the donor ICN 10–12 to both the ACB of ICN 3–4 (medially) and either the thoracodorsal, intercostobrachial, or LCB of ICN 4–5 (laterally) | Enhances tactile, temperature, vibratory, and overall sensory scores relative to single neurorrhaphy TRAM flap neurotization |
Zhou et al. [47] | 2018 | Described harvesting a short, sensory-only segment of ICN 11 or 12 with the abdominal flap | Preserves motor innervation to the abdominal wall and focuses reinnervation on afferent fibers |
Introduced the use of interpositional nerve allografts to bridge between short donor nerves and the ACB of ICN 3 in the chest | Enables neurorrhaphy over the longer distances that result from harvesting short sensory-only sections of abdominal ICN, without introducing donor site morbidity associated with nerve autograft harvest | ||
Momeni et al. [53] | 2021 | First study investigating long-term outcomes following flap neurotization with interpositional nerve allografts | Flap neurotization using nerve allograft allowed for tension-free and selective nerve coaptation to sensory nerve fibers, which resulted in improved return of protective sensation |
Djohan et al. [66] | 2023 | Performed flap neurotization using both an interpositional nerve allograft and nerve conduits to cover each coaptation site | Nerve conduits theoretically collect leaked neurotrophic factors at nerve ends while providing a protected environment for more effective nerve regeneration |
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Silverstein, M.L.; Momeni, A. Restoring Sensation through Abdominal Flap Neurotization in Breast Reconstruction. J. Clin. Med. 2024, 13, 3826. https://doi.org/10.3390/jcm13133826
Silverstein ML, Momeni A. Restoring Sensation through Abdominal Flap Neurotization in Breast Reconstruction. Journal of Clinical Medicine. 2024; 13(13):3826. https://doi.org/10.3390/jcm13133826
Chicago/Turabian StyleSilverstein, Max L., and Arash Momeni. 2024. "Restoring Sensation through Abdominal Flap Neurotization in Breast Reconstruction" Journal of Clinical Medicine 13, no. 13: 3826. https://doi.org/10.3390/jcm13133826
APA StyleSilverstein, M. L., & Momeni, A. (2024). Restoring Sensation through Abdominal Flap Neurotization in Breast Reconstruction. Journal of Clinical Medicine, 13(13), 3826. https://doi.org/10.3390/jcm13133826