Use of the anterior cutaneous branch of the third inter costal nerve to reinnervate the DIEP flap
https://doi.org/10.52581/1814-1471/82/01
Abstract
Today, the DIEP flap (deep inferior epigastric artery perforator flap) is becoming the most popular method of breast reconstruction after mastectomy. The next step in the evolution of this flap should be to improve its sensitivity in the postoperative period. Recovery of sensitivity in the reconstructed mammary gland improves the quality of life of patients, as well as restores the protective function of the skin. In addition, tactile sensitivity of the breast plays a very important role in the intimate life of women. However, the question of finding and isolating the recipient nerve for the purpose of reinnervation of the flap remains open. This fact was the reason for the search for the optimal surgical technique for this stage of the operation. The world literature describes some ways of reinnervation of the DIEP-flap (flap on the perforators of the deep inferior epigastric artery). All of them have their pros and cons. We propose to use the anterior cutaneous branch of the 3rd intercostal nerve as a recipient, which is located in the same microsurgical field as the internal thoracic vessels. This method, in our opinion, allows you to minimize the time to search for and isolate the recipient nerve.
About the Authors
A. A. AnelikovRussian Federation
Andrey A. Anelikov, graduate student, the Department of Oncology, Radiotherapy and Plastic Surgery, Institute of Clinical Medicine
8, Trubetskaya st., Moscow, 119991
Phone number: +7-985-803-0786
O. I. Startseva
Russian Federation
Olesya I. Startseva, Dr. Med. sci., Professor, the Department of Oncology, Radiotherapy and Plastic Surgery, Institute of Clinical Medicine
8, Trubetskaya st., Moscow, 119991
References
1. Sinelnikov M.E., Startseva O.I., Melnikov D.V., Ivanov S.I. Mikrososudistye aspekty revaskulyarizacii perforantnogo nizhnego epigastral'nogo loskuta pri rekonstrukcii molochnyh zhelez. Sechenovskiy vestnik – Sechenov Medical Journal. 2019;10(3):22-29. DOI: 10.26442/22187332.2019.3.22-29 (in Russ.).
2. Duadze I.S., Zikirнakhodzhaev A.D., Suhotko A.S., Starkova M.V., Usov F.N., Bagdasarova D.V., Dzhabrailova D.Sh., Khakimova Sh.G. Rekonstrukciya molochnoy zhelezy s ispol'zovaniem loskuta na perforante glubokoy nizhney epigastral’noy arterii (DIEP-flap). Istoriya razvitiya [Breast reconstruction using a deep inferior epigastric artery perforator flap (DIEP-flap). The history of development]. Issledovaniya i praktika v meditsine – Rese arch'n Practical Medicine Journal. 2021;8(3):108-117 (in Russ.).
3. Baytinger V.F., Silkina K.A. Chuvstvitel'naya innervaciya mikrohirurgicheskih loskutov, primenyaemyh v rekonstruktivnoy mammoplastike [Sensitive innervation of microsurgical flaps which are used in reconstructive mammoplasty. Voprosy rekonstruktivnoy i plasticheskoy hirurgii – Issues of Reconstructive and Plastic Surgery. 2014;2(49):11-19 (in Russ.).
4. Mahajan A.L., Chapman T.W., Mandalia M.R., et al. Sun burn as a consequence of resting reading glasses on a reconstructed breast. J Plast Reconstr Aesthet Surg. 2010;63:e170.
5. Kay A.R., McGeorge D. Susceptibility of the insensate reconstructed breast to burn injury. Plast Reconstr Surg. 1997;99:927.
6. Gowaily K., Ellabban M.G., Iqbal A., et al. Hot water bottle burn to reconstructed breast. Burns. 2004;30: 873-874.
7. Yap L.H., Whiten S.C., Forster A., Stevenson J.H. The anatomical and neurophysiological basis of the sensate free TRAM and DIEP flaps. Br J Plast Surg. 2002;55:35-45.
8. Allen R.J., Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg. 1994; 32:32-38.
9. Update on breast reconstruction using free TRAM, DIEP, and SIEA flaps. Seminars in Plastic Surgery. 2004;18(2):97-104. DOI: 10.1055/s-2004-829044
10. Mol F.M.U., Lataster A., Scheltinga M., Roumen R. Anatomy of abdominal anterior cutaneous intercostal nerves with respect to the pathophysiology of anterior cutaneous nerve entrapment syndrome (ACNES): A case study. Transl Res Anat. 2017;8-9:6-10.
Review
For citations:
Anelikov A.A., Startseva O.I. Use of the anterior cutaneous branch of the third inter costal nerve to reinnervate the DIEP flap. Issues of Reconstructive and Plastic Surgery. 2022;25(3):6-10. (In Russ.) https://doi.org/10.52581/1814-1471/82/01