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Comparison of Surgical Duration in Unilateral Neurotized and Non-Neurotized Abdominally Based Free Flap Breast Reconstruction
Isis Scomacao
Valerie Carbajal
Jonathan Wycrick
Risal Djohan
Andrea Moreira
Graham S Schwarz
Cleveland Clinic
2019-02-15
Presenter: Isis Scomacao
Affidavit:
Graham Schwarz
Director Name: Graham Schwarz
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: Compare length of surgical time between unilateral neurotized and non- neurotized abdominally based free flaps using a processed nerve allograft with nerve connector construct.
Methods: Retrospective review of consecutive patients who underwent unilateral free flap breast reconstruction (with or without neurotization) between June 2016 and June 2018 was undertaken. The length of surgery, oncologic/reconstructive treatment, and patients' demographics were reviewed. The neurotization procedure was performed utilizing a processed nerve allograft in combination with small intestinal submucosal connector covering each epineurial coaptation site. A nerve gap between a single cutaneous sensory branch from the abdominal flap and the anterior cutaneous branch of the intercostal nerve was bridged.
Results: Seventy three patients underwent unilateral breast reconstruction during this period. Among these patients, 23 (31.50%) were treated with a flap neurotization (N group) and 50 (68.49%) without it (NO group). The groups were similar in terms of age, BMI, ASA class and history of radiation therapy. In the N group, the majority of the reconstructions were immediate (52.17%) and in the NO group the majority were delayed-immediate (50%). No difference was found between the groups in terms of timing of reconstruction. The average of length of surgery was 467.73±145.52minutes and 447.07±105minutes for the group N and group NO, respectively (p=0.358).
Conclusion: The use of a nerve allograft and connector construct for neurotization of unilateral abdominally based free flaps in breast reconstruction with a single medial anterior cutaneous intercostal branch nerve recipient did not significantly increase the operative time.
