by Beugels, Jop; van Kuijk, Sander M. J.; Lataster, Arno;
van der Hulst, René R. W. J.; Tuinder, Stefania M. H.
Plastic and
Reconstructive Surgery: February 2021
- Volume 147 - Issue 2 - p 281-292
Background:
The lateral thigh perforator flap, based on the tissue of
the upper lateral thigh, is an excellent option for autologous breast
reconstruction. The aim of this study was to introduce the technique to perform
a nerve coaptation in lateral thigh perforator flap breast reconstruction and
to analyze the results by comparing the sensory recovery of the reconstructed
breast and donor site between innervated and noninnervated lateral thigh
perforator flaps.
Methods:
A prospective cohort study was conducted of patients who
underwent an innervated or noninnervated lateral thigh perforator flap breast
reconstruction between December of 2014 and August of 2018. Direct nerve
coaptation was performed between a branch of the lateral femoral cutaneous
nerve and the anterior cutaneous branch of the intercostal nerve. Sensory
testing was performed with Semmes-Weinstein monofilaments to assess the
sensation of the native skin, flap skin, and donor site during follow-up.
Results:
In total, 24 patients with 37 innervated lateral thigh
perforator flaps and 18 patients with 26 noninnervated lateral thigh perforator
flaps were analyzed (median follow-up, 17 and 15 months, respectively).
Significantly lower mean monofilament values were found for the native skin
(adjusted difference, −0.83; p = 0.011) and flap skin (adjusted difference,
–1.11; p < 0.001) of the reconstructed breast in innervated compared to
noninnervated flaps. For the donor site, no statistically significant
differences were found between both groups.
Conclusions:
Nerve coaptation in lateral thigh perforator flap breast
reconstruction resulted in a significantly better sensory recovery of the
reconstructed breast compared to noninnervated flaps. The data also suggest
that harvesting a sensory nerve branch does not compromise the sensory recovery
of the upper lateral thigh.
