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Anatomic Comparison of Recipient Nerves for Deep Inferior Epigastric Perforator Flap Neurotization: A Randomized
Gabriella E Glassman1, Salam Al-Kassis1, Patrick E Assi1
1From the Department of Plastic Surgery, Vanderbilt University Medical Center.
Annals of Plastic Surgery
|February 18, 2022
Summary
Neurotization in autologous breast reconstruction shows comparable sensory nerve counts in the third anterior cutaneous branch (ACB) and fourth lateral cutaneous branch (LCB). The fourth LCB is preferred if the third ACB is intact to preserve sensation.
Area of Science:
- Plastic Surgery
- Neuroanatomy
- Reconstructive Surgery
Background:
- Neurotization in autologous breast reconstruction aims to improve sensory outcomes but remains controversial.
- Debate exists regarding optimal recipient nerves for neurotization of the deep inferior epigastric perforator flap.
Purpose of the Study:
- To quantitatively compare the sensory nerve components of the third anterior cutaneous branch (ACB) and fourth lateral cutaneous branch (LCB) for deep inferior epigastric perforator flap neurotization.
Main Methods:
- Histoanatomical analysis of transected intercostal nerve specimens from 19 subjects undergoing bilateral autologous breast reconstruction.
- Immunohistochemical staining for total and motor neurons, with sensory axons calculated by difference.
- Axonal quantification using ImageJ software.
Main Results:
- Thirty-eight nerves were analyzed; mean sensory axon counts were 1246.3 (±1171.9) in the fourth LCB and 1123.8 (±1213.0) in the third ACB.
- The fourth LCB showed a trend towards a higher sensory axon count (10.9%, P > 0.05).
- Sensory fibers constituted 36.7% of the third ACB and 31.7% of the fourth LCB.
Conclusions:
- The third ACB and fourth LCB possess comparable numbers of sensory axons, making them suitable recipient nerves for deep inferior epigastric perforator flap reinnervation.
- Both nerves can facilitate sensory return after breast reconstruction.
- The fourth LCB is recommended when the third ACB is intact to preserve native sensation.
