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Neurotization in Innervated Breast Reconstruction: A Systematic Review of Techniques and Outcomes.
Shiah, Eric; Laikhter, Elizabeth; Comer, Carly D; Manstein, Samuel M; Bustos, Valeria P; Bain, Paul A; Lee, Bernard T; Lin, Samuel J.
Afiliação
  • Shiah E; Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; 330 Brookline Ave., Boston, Massachusetts, 02115.
  • Laikhter E; Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; 330 Brookline Ave., Boston, Massachusetts, 02115.
  • Comer CD; Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; 330 Brookline Ave., Boston, Massachusetts, 02115.
  • Manstein SM; Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; 330 Brookline Ave., Boston, Massachusetts, 02115.
  • Bustos VP; Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; 330 Brookline Ave., Boston, Massachusetts, 02115.
  • Bain PA; Countway Library, Harvard Medical School; 10 Shattuck St., Boston, Massachusetts, 02115.
  • Lee BT; Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; 330 Brookline Ave., Boston, Massachusetts, 02115.
  • Lin SJ; Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; 330 Brookline Ave., Boston, Massachusetts, 02115. Electronic address: sjlin@bidmc.harvard.edu.
J Plast Reconstr Aesthet Surg ; 75(9): 2890-2913, 2022 09.
Article em En | MEDLINE | ID: mdl-35872020
BACKGROUND: Significant improvements in sensory recovery after innervated breast reconstruction have been reported. However, surgical approaches and sensory testing methods have been widely variable. This systematic review aimed to synthesize neurotization techniques and outcomes in breast reconstruction surgery. METHODS: A comprehensive literature search of the MEDLINE, Embase, Web of Science, and Cochrane databases was conducted to identify all studies reporting outcomes of neurotization in innervated breast reconstruction. Data extracted from each study included neurotization techniques, operative times, sensory methods and outcomes, and patient-reported outcomes. RESULTS: A total of 1,350 articles were identified, and 23 articles were included for analysis. Nerve coaptation was performed in 536 breasts and 419 patients, with techniques consisting of direct coaptation (65.1% of flaps), coaptation with nerve conduit (26.3%), and coaptation with nerve allograft (8.6%). The neural component of operating time ranged from 8 to 38 min, and the pooled neurotization success rate among nine studies that reported this outcome was 90.6% (95% CI: 83.6%-96.0%). Overall, innervated breasts achieved earlier and superior sensory recovery that was more uniformly distributed throughout the flap compared to non-innervated breasts. Despite high heterogeneity between studies, all included studies supported neurotized breast reconstruction to improve the rate, quality, and magnitude of sensory recovery. CONCLUSIONS: Neurotization during breast reconstruction may be worth the investment of additional operating time to increase the prospect of high-quality sensory recovery. Further investigation with standardized sensory testing methods and patient-reported outcome tools is needed to definitively support neurotization as a standard of care in breast reconstruction surgery.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transferência de Nervo / Mamoplastia Tipo de estudo: Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: J Plast Reconstr Aesthet Surg Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Transferência de Nervo / Mamoplastia Tipo de estudo: Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: J Plast Reconstr Aesthet Surg Ano de publicação: 2022 Tipo de documento: Article