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Determining Location of Abdominal Motor & Sensory Nerves for Functional for its Utilization in Breast Reconstruction: Cadaver Study
Cagri Cakmakoglu,MD; Michelle Djohan,BS; Rebecca Knackstedt,MD; James Gatherwright,MD; Risal Djohan,MD
Cleveland Clinic Foundation
2018-02-15
Presenter: CAGRI CAKMAKOGLU
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Risal Djohan,MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction: Most of the breast reconstruction cases still result in senseless or numbness in the reconstructed breast and also atrophy of the abdominal wall muscles is a dangerous complication that could lead to the need for further surgical intervention. There has been some description in abdominal based free flap reconstruction which would incorporate sensory nerve into the flap. But the location of these sensory nerves that are protected during the flap harvest has not been well described. The aim of this study is to determine the location the sensory and motor nerves of the abdomen in consistent distribution and location.
Materials & Methods: Dissection of 8 cadavers (16 hemi deep inferior epigastric artery perforator flap) were performed. Location and number of the nerves and relation with the abdominal wall perforators were recorded.
Results: Average distance of superficial nerves from the umbilicus and anterior superior iliac spine (ASIS) were 3.40(±)2.6 cm lateral, 6.4(±)4.36 cm inferior and 10.9(±)3.63 cm medial; 0.9(±)5.02 cm inferior, respectively. Average distance of deep nerves from the umbilicus and ASIS were 11.51(±)4.4 cm lateral, 3.02(±)5.43 cm inferior; 1.97(±)4.07 cm medial, 3.02(±)4.24 cm superior, respectively. Three isolated nerves piercing the external oblique muscle to supply abdominal wall were found.
Conclusions: Finding a more precise location and determining which is the most common location of the nerves would be beneficial knowledge for surgeons who use sensate flaps for abdominal based breast reconstruction. The hope is that, this knowledge will allow surgeons to locate these nerves quicker and more easily during the flap harvest.
