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A Microneurovascular TRAM Flap Does Not Compromise Abdominal Sensibility More Than a Conventional One

Puonti, Helena K. M.D.; Jääskeläinen, Satu K. M.D., Ph.D.; Hallikainen, Helena K. M.D.; Partanen, Taina A. M.D., Ph.D.

doi: 10.1097/PRS.0b013e31825dbedd
Breast: Original Articles

Background: Classic abdominoplasty for a transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction impairs abdominal somatosensory function at the donor site. The aim of this study was to investigate whether the type of surgical procedure has an effect on somatosensory alterations of abdominal skin after TRAM flap breast reconstruction.

Methods: Sixty patients (mean ± SD age, 50 ± 6.0 years) who underwent microvascular TRAM flap breast reconstruction and 20 healthy subjects (control group; mean age, 46 ± 6.7 years) participated in the study. Twenty patients had bilateral-nerve anastomosis, 20 had single-nerve anastomosis, and 20 underwent no nerve dissection for the TRAM flap. Clinical sensory examination and tactile and thermal quantitative sensory testing were performed and a patient questionnaire was administered at a mean of 2 to 4.5 years after surgery.

Results: All surgical techniques produced significant sensory impairment below the umbilicus, but there were no significant differences in total sensibility scores between the groups with single-nerve (mean sensibility score, 21.98 ± 2.7) and double-nerve (mean sensibility score, 20.71 ± 3.6) anastomosis of the TRAM flap. The best sensibility scores were found in the group with single-nerve dissection. Fifteen percent of patients complained of mild pain, and 13 percent felt occasional tactile hyperesthesia in their abdominal skin, mostly around the umbilicus and scars.

Conclusions: In this study, unilateral or bilateral nerve dissection when preparing and lifting a TRAM flap did not seem to increase sensory alterations or postoperative pain in the abdominal donor site after breast reconstruction surgery. Cautious microneurovascular dissection techniques may even improve sensory recovery of the abdominal skin after TRAM flap breast reconstruction surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Savonlinna, Turku, and Lappeenranta, Finland

From the Departments of Surgery and Clinical Neurophysiology, Savonlinna Central Hospital; the Department of Clinical Neurophysiology, Turku University Hospital; and the Department of Surgery, South Karelia Central Hospital.

Received for publication January 11, 2012; accepted April 2, 2012.

Disclosure: The authors have no financial interest in any of the products, devices, or procedures mentioned in this article.

Helena K. Puonti, M.D.; Department of Surgery, Savonlinna Central Hospital, Matarintie 270, 57310 Savonlinna, Finland, plastiikkakirurgia.helena@kolumbus.fi

©2012American Society of Plastic Surgeons