Nerve Coaptation is Associated with Improved Sensation After Microvascular Breast Reconstruction: A Systematic Review of Objective Outcomes
Jesse Chou, BA, Western Michigan University, Kalamazoo, MI and Justin M Broyles, MD, Harvard University, Boston, MA
BACKGROUND
Return of sensation after autologous breast reconstruction is an important outcome. While partial sensation spontaneously returns from peripheral axonal sprouting, several studies have demonstrated improved recovery of sensation with flap neurotization. However, the overall body of literature represents a large group of patients with heterogenous outcome measures and inconsistent follow-up. The purpose of this study is to identify sensory outcomes after neurotization of microvascular breast reconstruction flaps using Semmes-Weinstein Monofilaments (SWM) to accurately determine pressure thresholds of sensory recovery as a uniform, objective outcome measurement. We hypothesize that patients who underwent neurotization will demonstrate quantifiably improved return of sensation when compared with comorbidity-matched controls without nerve coaptation.
METHODOLOGY
Pubmed/Medline and Embase databases were queried on June 1st, 2020 to include all English language articles published between January 1, 1990 and January 1, 2020. Inclusion criteria included studies with patients undergoing autologous breast reconstruction and use of SWM to quantify return of sensation after either neurotization or no neurotization. Exclusion criteria included reviews, case reports, and studies utilizing implants or latissimus dorsi flaps.
RESULTS
Overall, 505 titles were screened. 494 titles were excluded. 11 articles met inclusion criteria and were analyzed for 419 patients total. Four articles had level 3 evidence, and 7 articles had level 4 evidence. Within this cohort, there were a total of 182 non-neurotized patients included as controls (Group A) and 237 neurotized patients (Group B). Mean follow-up time was shorter in group B (21 months vs. 31.7 months, p<0.05). 14% (1/7) of articles with neurotized patients utilized an allograft.
There was no significant difference in age (Group A = 48.2 years vs. Group B = 49.9 years) or BMI (Group A =25.6 vs. Group B = 25.0) between groups. More group B patients received radiation therapy (Group B=48.9% vs. Group A =31.69, p<0.05). Patients that received neurotization had lower mean pressure thresholds (Group B 13.59 gm/mm2 vs. Group A 43.55 gm/mm2, p<0.05) than comorbidity-matched controls who were not neurotized.
CONCLUSION
Neurotization has been shown to be a safe and feasible option for enhancing return of sensation after breast reconstruction. While sensation has multiple components, our results suggest that neurotization can quantifiably improve sensitivity to pressure thresholds when compared with non-neurotized patients even in the setting of post-mastectomy radiation therapy. Future work using larger numbers of patients with standardized, long-term follow-up will further elucidate the pattern of return of breast sensation and the impact of neurotization.
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