American Society for Peripheral Nerve
ASPN Home ASPN Home Past & Future Meetings Past & Future Meetings

Back to 2023 Abstracts


Connect the Wires: The Efficacy of Nerve Grafts in Sensory Recovery Following DIEP Flap Breast Reconstruction
Marcos Lu Wang, BA1; Hao Huang, MD2; Angela Ellison, MS1; Paul A Asadourian, MEng3; David M Otterburn, MD1
1Weill Cornell Medicine, New York, NY; 2NewYork-Presbyterian, New York, NY; 3Columbia University Vagelos College of Physicians and Surgeons, New York, NY

Background: Poor breast sensation is commonly reported after mastectomy and reconstruction due to the necessary disruption of sensory nerves during surgery. During deep inferior epigastric perforator (DIEP) flap reconstruction at our institution, we routinely coapt at least one of the 10th, 11th, or 12th intercostal nerve within the autologous flap to the anterior cutaneous branch of the 3rd intercostal nerve using a nerve allograft. In this study, we aim to evaluate the efficacy of nerve grafting in improving sensory recovery following neurotized DIEP flap reconstruction.
Methods: Thirty patients (54 breasts) underwent immediate neurotized DIEP flap reconstruction using the 70 x 1–2 mm Avance nerve graft. Sensitivity evaluation was performed in nine breast regions, utilizing the AcroVal pressure-specified sensory device to determine 1-point static cutaneous thresholds at which stimulus was perceived. Higher measurements indicated worse sensitivity. For each patient, sensation was compared between two time points: 3 to 6 months postoperatively versus 12 to 24 months postoperatively. The reconstructive BREAST-Q questionnaire was used to survey patients’ satisfaction of their breasts, physical wellbeing, psychosocial wellbeing, and sexual wellbeing. Two-sample unpaired t-test was used to compare continuous variables across timepoints.
Results: At 3 to 6 months postoperatively, patients had a mean sensitivity measurement of 52.1 g/mm2. At 12 to 24 months postoperatively, patients had a mean sensitivity measurement of 40.3 g/mm2. There was a significant decrease in the mean cutaneous threshold required for patients to perceive sensation between the two time points (–29.1 percent, p = 0.041, Figure 1). Of the patients tested at 24 months postoperatively, sensitivity measurements were comparable to preoperative baseline levels (p = 0.080). On the reconstructive BREAST-Q, patients scored significantly higher in breast satisfaction (56.7/100 versus 75.1/100, +32.5 percent, p = 0.032) and physical wellbeing (66.0/100 versus 85.5/100, +20.2 percent, p= 0.022) between the two time points. There were no significant increases in psychosocial wellbeing and sexual wellbeing scores (p > 0.05).
Conclusions: Patients who undergo nerve graft-based DIEP flap reconstruction can expect significant improvements in sensation to pressure over time. This improvement found on sensory testing correlates with significant improvement in patients’ satisfaction of their reconstructed breasts and physical wellbeing. Our results can help inform preoperative counseling and guide patient expectations on the timeline of sensory recovery following surgery.


Back to 2023 Abstracts