Evaluation of abdominal sensibility after TRAM flap breast reconstruction

Citation
Sl. Spear et al., Evaluation of abdominal sensibility after TRAM flap breast reconstruction, PLAS R SURG, 106(6), 2000, pp. 1300-1304
Citations number
8
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Surgery,"Medical Research Diagnosis & Treatment
Journal title
PLASTIC AND RECONSTRUCTIVE SURGERY
ISSN journal
0032-1052 → ACNP
Volume
106
Issue
6
Year of publication
2000
Pages
1300 - 1304
Database
ISI
SICI code
0032-1052(200011)106:6<1300:EOASAT>2.0.ZU;2-0
Abstract
One commonly expressed concern regarding transverse rectus abdominis myocut aneous (TRAM) flap breast reconstruction surgery is the return of sensation to the abdomen. Although many studies have focused on abdominal wall muscl e incompetence or herniation, there is limited literature discussing postop erative abdominal sensation. The purpose of this study was to assess abdomi nal sensation a minimum of 1 year after pedicled TRAM flap surgery for brea st reconstruction. Twenty-five female patients who underwent TRAM flap breast reconstruction a minimum of 1 year before the study were compared with 10 female volunteer controls. Subject and control abdomens were specifically divided into 12 zo nes, then assessed for superficial touch, super ficial pain, temperature, a nd vibration using various techniques. Fischer's exact test was used for an alysis with the p, value set at p = 0.05. The degree to which superficial t ouch was affected was then tested using Semmes-Weinstein monofilaments. Stu dent's t test was used for analysis with the p, value set at p = 0.05. For all four sensory modalities, subjects were found to have decreased sens ation in zones 5 and 8, the supraum-bilical and infraumbilical regions. Thi s was statistically significant. When assessed with Semmes-Weinstein monofi laments, the sensation of the subjects' abdomens was significantly decrease d compared with controls. Significance was found in all zones. This study clearly demonstrates that there is a significant and persistent reduction in abdominal sensibility following TRAM flap surgery. The distrib ution of the deficits is consistent and involves the midline supraum-bilica l and infraumbilical regions. The TRAM flap has become the procedure of choice for postmastectomy autogen ous breast reconstruction. It provides the plastic surgeon with a relativel y safe, reliable, and aesthetically pleasing method of breast reconstructio n. Since its inception, the TRAM flap and its abdominal closure have underg one numerous modifications designed to minimize donor-site morbidity and cr eate a natural-looking breast. In addition to creating an aesthetically ple asing breast, the TRAM flap has the potential advantage of postoperative im provement in abdominal contour.