Improved sensory recovery with a novel dual neurorrhaphy technique for breast reconstruction with free muscle sparing TRAM flap technique

BackgroundWe describe a new dual neurorrhaphy method for a free abdominal-based flap and compare sensory recovery with this novel technique to that with conventional neurorrhaphy technique for breast reconstruction. Methods70 breast cancer patients underwent muscle sparing innervated transversal rectus abdominis myocutaneous flap (neuro ms-TRAM) breast reconstruction with either a novel dual neurorrhaphy technique (N=41) or single (N=29) neurorrhaphy only. Dual neurorrhaphy was performed on both sides and single neurorrhaphy on one side of the flap, using the end-to-end or end-to-side technique. Two years postoperatively, quantitative sensory testing (QST) was performed for tactile, and thermal sensory modalities, and other tests included sharp-blunt, vibration, and two-point discrimination. Sensory modalities were scored either zero (abnormal) or one point (normal) at each test site against normal reference values (five sites for most tests). The total sensory scores (TSC) were calculated on the basis of the sums of the individual test scores, and all data are presented as the median (interquartile range, IQR). ResultsThe median of TSC in the breast reconstruction with the dual neurorrhaphy was higher (15.3, IQR 11.8-19.4), than that with the single neurorrhaphy (11.5, IQR 9.1-17.4) (P=0.037). Regarding the different sensory modalities, the dual technique especially enhanced the tactile (P=0.005) and cool detection (P=0.021) recovery compared to the single neurorrhaphy. ConclusionsDual neurorrhaphy improved the sensory recovery of the reconstructed breast, and may therefore be recommended for clinical practice. (c) 2014 Wiley Periodicals, Inc. Microsurgery 37:21-28, 2017.