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Donor Nerve Selection: Objective and Patient-Reported Sensory Outcomes in Neurotized Deep Inferior Epigastric Perforator Flaps
Ashley Zhang
*, Marcos Lu Wang, Hao Huang, Grant G. Black, Sophia Arbuiso, Chase Alston, Isaiah J. Rhodes, David Otterburn
Plastic and Reconstructive Surgery, Weill Cornell Medicine, New York, NY
BackgroundThe deep inferior epigastric perforator (DIEP) flap can be reliably neurotized for autologous breast reconstruction. In standard fashion, a sensory branch of T10, T11, or T12 of the DIEP flap is coapted to the anterior cutaneous branch of T3 at the recipient site. In this study, we compare objective sensation recovery and patient-reported sensation, for DIEP flaps innervated by T11 versus T12.
MethodsPatients undergoing neurotized DIEP flap reconstruction after mastectomy were prospectively identified. All nerve coaptation was performed with an allograft between T11 or T12 to T3; the donor nerve was selected by the surgeon based on intraoperative viability and appearance. Sensation testing was performed with a pressure-specified sensory device in four quadrants of the breast and at the nipple-areolar complex at specified time points. Higher values correlate to a higher threshold of pressure needed to elicit sensation. Patients were additionally invited to complete the Sensation Module of the BREAST-Q postoperatively.
Results65 neurotized DIEP flaps in 42 patients were included; 35 flaps innervated with T11 and 30 flaps innervated with T12. Preoperative breast sensitivity measurements were comparable between the two groups. In the first six months after reconstruction, breasts innervated by T12 were more sensitive in the medial quadrant (p = 0.019). Six to twelve months after reconstruction, the T12 cohort had greater sensitivity in most breast regions (p<0.05). After 12 months, T12 sensation was superior in the inferior and lateral quadrants (p<0.05). Postoperative patient-reported breast sensation and breast symptoms were similar, but patients with T12-innervated reconstruction had higher quality-of-life impact BREAST-Q scores, trending toward significance (76.86 vs. 56.83, p=0.230).
ConclusionsDIEP flaps innervated with T12 have superior objective sensation recovery and patient-reported quality-of-life compared to flaps innervated with T11. Although anatomy is patient specific, use of T12 is most favorable when considering flap reinnervation.
Figure 1: Measured Breast Sensation in Neurotized DIEP Flaps Over Time
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