Application of free innervated deep inferior epigastric artery perforator flap in breast reconstruction
Wang Lei1, Song Aili1, Song Dajiang2, Li Zan2, Zhou Bo2, Lyu Chunliu2, Wu Peng2, Tang Yuanyuan2
1Department of Breast and Thyroid Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, China; 2Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha 410008, China
Abstract：Objective This study aimed to explore the clinical application methods and outcomes of innervated deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction.Methods A retrospective analysis was conducted on 12 female patients with unilateral early breast cancer (clinical stage Ⅰ/Ⅱ) who were admitted from October 2015 to February 2017 in Hunan Cancer Hospital and received modified radical surgery and breast reconstruction by using the DIEP flap with sensory nerve repair (the sensory branch of intercostal nerve in the flap was coated with the third intercostal nerve). The patients' age ranged from 33 years to 52 years (mean age, 37.4±3.5 years). In all flap transplantations, the deep inferior epigastric vessels were anastomosed with internal mammary vessels or thoracodorsal vessels in the recipient sites. Each breast was subdivided into four quadrants. One central region with pressure, hot, and cold recognition was tested in every area. Each patient received a questionnaire asking for their subjective opinion about their breast shape outcome, return of sensation, erogenous sensation, and overall satisfaction.Results The flap had a length of (32.3±0.4)cm, width of (12.7±1.6)cm, and thickness of (3.8±0.4) cm. The length of pedicle was (12.5±0.4) cm, the outer diameter of artery pedicle was (1.7±0.4)mm, and the outer diameter of venae comitant was (2.2±0.7)mm. The length of sensory branch of intercostal nerve was (2.3±0.4)cm. The recipient vessels included internal mammary vessels (seven cases) and thoracodorsal vessel (five cases). All the recipient nerves are the third intercostal nerve. All flaps were successfully implanted. In one flap donor site, fat necrosis occurred and healed with dressing treatment. No other complications were noted. The reconstructed breasts' shape, texture, and elasticity were good, and no flap contracture deformation was noted. Only linear scar was left in the donor sites, and the abdominal function was not affected. All 12 patients were followed up for 12-38 months (averaged 19.6 months) with satisfying results. No local recurrence happened. At 12 months after breast reconstruction, the neurotization of the DIEP flap resulted in the recovery of sensibility. In all 12 cases (100%) of the DIEP flaps with sensory nerve repair, at least protective sensation was present in all five segments of the breast. Responses to cold or warm stimuli were still present.Conclusions DIEP flap neurotization using the third anterior intercostal nerve is an effective technique to increase the sensory recovery for patients undergoing breast reconstruction.
王蕾, 宋爱莉, 宋达疆, 李赞, 周波, 吕春柳, 伍鹏, 唐园园. 游离带感觉神经腹壁下动脉穿支皮瓣在乳房再造中的应用[J]. 中华解剖与临床杂志, 2021, 26(3): 320-325.
Wang Lei, Song Aili, Song Dajiang, Li Zan, Zhou Bo, Lyu Chunliu, Wu Peng, Tang Yuanyuan. Application of free innervated deep inferior epigastric artery perforator flap in breast reconstruction. Chinese Journal of Anatomy and Clinics, 2021, 26(3): 320-325.
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2021, Vol. 26 
