Abstract
Background The spontaneous reinnervation of free flaps, such as deep inferior epigastric perforator
(DIEP) flaps, is not fully understood, and few publications have investigated this
issue. The aim of this study was to examine spontaneous reinnervation following breast
reconstruction with autologous DIEP flaps without an additional nerve transfer.
Methods In a retrospective clinical study, 18 female patients were investigated for a mean
of 49.59 months (range, 12–88 months) following breast reconstruction with a unilateral
DIEP flap. Five sensory modalities were tested: pressure perception, dynamic two-point
discrimination, sharp-blunt discrimination, hot and cold discrimination, and vibration
perception threshold (VPT). The measurements were performed on the reconstructed breast,
flap surrounding transition zone, healthy contralateral breast, and the donor site.
For a more precise analysis all breasts have been divided into five different segments
(mediocranial, laterocranial, mediocaudal, laterocaudal, and reconstructed nipple–areola
complex, if present). Additionally, tissue oxygen saturation and tissue hemoglobin
were measured by laser Doppler spectroscopy.
Results Spontaneous reinnervation of at least one modality tested was observed in all DIEP
flaps (n = 18). This sensitive recovery increases over the postoperative period. The maximum
difference between the controls and DIEP flaps was observed in cold perception, whereas
the least difference was observed in the VPT. Regarding the different segments, we
observed better sensitive recovery in the cranial parts of the DIEP flaps and the
transition zone.
Conclusion This study provides certain predictions for patients and surgeons, when and to which
extent spontaneous reinnervation can be expected.
Keywords
DIEP flap - breast reconstruction - flap sensitivity - spontaneous reinnervation -
Semmes–Weinstein - laser Doppler spectroscopy
