Sensory Reinnervation With Subcutaneously Embedded Innervated Flaps
Sensory Reinnervation With Subcutaneously Embedded Innervated Flaps
复制标题
皮下嵌入神经支配皮瓣的感觉神经再支配
DOI：
10.1097/sap.0000000000002973
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发表时间：
2021
影响因子：
1.5
通讯作者：
Kubo Tateki
中科院分区：
文献类型：
--
作者：
Otani Naoya;Tomita Koichi;Taminato Mifue;Kuroda Kazuya;Yano Kenji;Kubo Tateki
背景在乳房再造术中，美学效果和感觉功能对术后生活质量都很重要。神经支配皮瓣在传统乳房切除术（CM）后的重建中是有用的，这使得大部分皮肤桨暴露在体表上。然而，它们是否也适用于皮肤保留乳房切除术（SSM）和乳头保留乳房切除术（NSM）仍不清楚。本研究旨在通过大鼠模型研究神经支配皮瓣在SSM和NSM术后感觉恢复中的作用。方法除胸13节背皮神经内侧支外，完全切除大鼠背皮神经，形成神经支配区被去神经支配区包围。将神经支配区提升为神经支配岛状皮瓣，然后皮下嵌入，将皮肤桨叶全部深度去皮（NSM组，n= 5）或除中心外（SSM组，n= 6）。对照组（CM组，n= 5）将皮瓣缝合回原位。术后机械感觉野的变化采用皮干肌反射试验评估。术后第12周对新机械性感觉野的再生神经进行免疫组化评价。结果SSM组和CM组机械感觉野在皮肤桨叶周围扩大。在NSM组，术后第4周出现了一个新的机械感觉野，并在此后扩大。术后第12周，SSM组和NSM组的机械感觉野面积无显著差异，但与CM组相比明显较小，与原始皮瓣面积相当。组织学上，s100和PGP9。新机械性感觉野真皮及皮下皮瓣组织中可见5条阳性神经纤维。结论皮下嵌入神经支配岛状皮瓣可诱导失神经皮肤的神经再生和感觉神经再支配，提示神经支配皮瓣在ssm /NSM后重建中也有应用价值。
BackgroundIn breast reconstruction, both aesthetic outcomes and sensory function are important for postoperative quality of life. Innervated flaps are useful in reconstruction after conventional mastectomy (CM), which leaves a large portion of the skin paddle exposed on the body surface. However, whether they are also useful in skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) remains unclear. This study aimed to examine the usefulness of innervated flaps in restoring sensation after SSM and NSM using a rat model.MethodsDorsal cutaneous nerves of rats were entirely eliminated except for the medial branch of the dorsal cutaneous nerve of thoracic segment 13, resulting in an innervated field surrounded by a denervated field. The innervated field was elevated as an innervated island flap and then subcutaneously embedded, with the skin paddle deepithelialized entirely (NSM group, n= 5) or except at the center (SSM group, n= 6). In the control model (CM group, n= 5), the flap was sutured back into its original position. Postoperative changes in the mechanonociceptive field were evaluated using the cutaneous trunci muscle reflex test. Immunohistochemical evaluation of regenerated nerves in the new mechanonociceptive field was performed at postoperative week 12.ResultsIn the SSM and CM groups, the mechanonociceptive field expanded around the skin paddle. In the NSM group, a new mechanonociceptive field appeared at postoperative week 4 and expanded thereafter. Areas of the mechanonociceptive field at postoperative week 12 did not differ significantly between the SSM and NSM groups, but were significantly smaller compared with the CM group and comparable to original flap areas. Histologically, S100-and PGP9. 5-positive nerve fibers were observed in the dermis of the new mechanonociceptive field and subcutaneous flap tissue.ConclusionsSubcutaneously embedded innervated island flaps induced nerve regeneration and sensory reinnervation of the denervated skin, suggesting that innervated flaps may also be useful in reconstruction post-SSM/NSM.