Direct neurotization of free nipple grafts with cadaveric nerve grafts following mastectomy for gender affirming surgery

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-03-29 DOI:10.1002/micr.31174
Atlee M. Loughran MD, Jennifer M. Hopkins BS, Elizabeth Kidney-Hilt BS, Kathryn Doshi PA-C, Jonathan Keith MD, FACS
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Abstract

Background

Free nipple grafting makes sensory recovery challenging. Permanent decreased sensation to touch and temperature in skin-grafted skin is common. Direct neurotization of the nipple-areolar complex (NAC) graft has been described. However, quantitative data regarding degree of nipple reinnervation possible is unknown. This study aims to quantify and qualify sensation recovery following nerve coaptation to reinnervate the NAC.

Methods

Patients undergoing mastectomy for gender dysphoria from 2020 to 2022 were offered nerve allograft to restore nipple sensation. A lateral intercostal nerve was selected and coapted to allograft which was embedded beneath the nipple graft. Semmes Weinstein testing was used to assess nipple sensation. Assessments were made at visits <1 year and >1 year from surgery. Filaments used represented normal sensation, minor diminished sensation, diminished sensation, loss of protective sensation, and deep pressure sensation only.

Results

A total of 115 patients elected for direct neurotization. Semmes Weinstein testing was limited to 46 patients representing 46 encounters and 92 nipples in the <1 year group and 24 encounters and 48 nipples in the >1 year group. Of the 92 nipples in the <1 year group, 17 (18.5%) noted return of normal sensation and 37 (40.2%) noted minor diminished or diminished sensation, indicating nerve reinnervation. There were 38 (41%) nipples with loss of protective sensation or deep sensation only. There were 48 nipples included in the >1 year group. Of the 48 nipples, 4 (8.3%) noted normal sensation and 30 (62.5%) noted minor diminished or diminished sensation, indicating nerve reinnervation. For the remaining 14 nipples, 14 (29%) noted loss of protective sensation or deep sensation only.

Conclusion

Sensory outcomes in NAC grafts used for reconstruction in patients undergoing double incision mastectomy remain poor. Sensation restoration beyond that expected from full thickness skin grafts can be achieved in the majority of patients with nerve allograft via direct neurotization.

Abstract Image

在乳房切除术后用尸体神经移植物直接神经化游离乳头移植物,以进行性别平权手术。
背景:游离乳头移植术给感觉恢复带来了挑战。植皮后的皮肤对触觉和温度的永久性感觉减退很常见。乳头乳晕复合体(NAC)移植物的直接神经化已被描述过。然而,有关乳头神经再支配程度的定量数据尚不清楚。本研究旨在量化和鉴定神经接合以重新支配 NAC 后的感觉恢复情况:方法:2020 年至 2022 年期间,因性别障碍接受乳房切除术的患者接受神经异体移植,以恢复乳头感觉。选择了一侧肋间神经,并与异体神经吻合,将其嵌入乳头移植物下方。Semmes Weinstein 测试用于评估乳头感觉。评估在手术后 1 年进行。使用的丝线代表正常感觉、轻微感觉减弱、感觉减弱、失去保护性感觉和仅深压感觉:共有 115 名患者选择了直接神经化。塞姆斯-韦恩斯坦测试仅限于 46 名患者,分别代表 46 次和 1 年组的 92 个乳头。在 1 年组的 92 个乳头中在 48 个乳头中,4 个(8.3%)感觉正常,30 个(62.5%)感觉轻微减弱或减弱,这表明有神经再支配。其余 14 个乳头中,有 14 个(29%)失去了保护性感觉或仅有深层感觉:结论:接受双切口乳房切除术的患者使用 NAC 移植物重建乳房的感觉效果仍然不佳。大多数患者可以通过神经异体移植的直接神经化来实现超出全厚皮肤移植预期的感觉恢复。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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