Nerve Coaptation in DIEP Flap Breast Reconstruction

Study Overview
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Brief Summary
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The sensory recovery of the breast remains an undervalued aspect of breast reconstruction and surgical reinnervation is not regarded as a priority by most reconstructive surgeons. A prospective study was conducted of all patients who underwent either innervated or non-innervated DIEP flap breast reconstruction in Maastricht University Medical Center and returned for follow-up between September 2015 and July 2017. Semmes-Weinstein monofilaments were used for sensory testing of the breast. This study showed that nerve coaptation in DIEP flap breast reconstruction resulted in a significantly improved sensation of the reconstructed breast compared to non-innervated flaps.

Official Title
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Sensory Recovery of the Breast Following Innervated and Non-innervated DIEP Flap Breast Reconstructions

Conditions
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Breast Cancer

Intervention / Treatment
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* Procedure: Sensory nerve coaptation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female patients 18 years or older Unilateral or bilateral DIEP flap breast reconstruction Returned for follow-up between September 2015 and July 2017 Informed consent Exclusion Criteria: Bilateral breast reconstruction with a unilateral innervated DIEP flap and a contralateral non-innervated flap Flaps that required a take-back

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Innervated DIEP flaps<br>Patients in this group underwent immediate or delayed, unilateral or bilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction with additional sensory nerve coaptation. | Procedure: Sensory nerve coaptation<br>* A recipient sensory nerve of the abdomen was reattached to a donor nerve in the chest area. The sensory branch of usually the 11th intercostal nerve was used as recipient nerve for nerve coaptation and the anterior cutaneous branch of the third intercostal nerve was used as donor nerve. Direct, end-to-end nerve coaptation was performed with two stitches.<br>* Other names: Reinnervation;|
| Non-innervated DIEP flaps<br>Patients in this group underwent immediate or delayed, unilateral or bilateral deep inferior epigastric artery perforator (DIEP) flap breast reconstruction without sensory nerve coaptation. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The extent of sensory recovery of the reconstructed breast to touch | The sensory recovery of the breast to touch was tested at different follow-up moments after the initial surgery. Semmes-Weinstein monofilaments were used for sensory testing. Nine areas of the breast, indicating native skin and flap skin, were tested. Mean monofilament values were calculated for each area and compared between groups. | Through study completion up to 24 months postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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breast reconstruction, DIEP flap, Nerve coaptation, Sensory recovery