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Schafer HA, Leathers KO, Mumford KC, Ilangovan S, Vetter IL, Henry SL, Kelley BP, Torres-Guzman RA, Egeland BM. "Toward Breast Reinnervation- What is our Endpoint" A systematic review of normal breast sensibility. J Plast Reconstr Aesthet Surg 2024; 91:383-398. [PMID: 38461623 DOI: 10.1016/j.bjps.2024.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND To restore breast sensibility, some centers are offering nerve reconstruction as a component of implant and flap-based breast reconstruction. To interpret and contextualize the results of these procedures, it is necessary to understand the normal range of breast sensibility, the factors that affect it, and the best methods for its objective measurement. METHODS We conducted systematic and comprehensive searches across PubMed, Web of Science, and Cochrane Library databases using keywords and controlled vocabulary for the concepts of the breast, nipple, areola, and measurement. The search results were imported into Rayyan QCRI for a blinded screening of titles and abstracts. Studies were evaluated for bias using RevMan 5 software. The results of sensory measurements were pooled, and a quantitative summary of breast sensibility was generated. RESULTS A total of 36 articles were identified, including retrospective, cross-sectional, and prospective studies. Although there were some consistent findings across studies, such that breast sensibility is inversely related to breast volume, there was wide variability in the following parameters: population, breast condition, measurement modality, anatomic areas of measurement, and sensibility findings. This heterogeneity precluded the generation of normative breast sensibility measurements. Furthermore, we detected a high degree of bias in most studies, due to self-selection of participants and failure to record patient characteristics that may alter sensibility. CONCLUSIONS The literature lacks consistent data delineating normative values for breast sensibility. Standardized measurements of healthy volunteers with various breast characteristics are necessary to elucidate normative values and interpret efforts to restore sensibility in breast reconstruction.
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Affiliation(s)
- Helen A Schafer
- The University of Texas at Austin Dell Medical School, Austin, TX, USA; Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Kaylee O Leathers
- The University of Texas at Austin Dell Medical School, Austin, TX, USA; Department of Plastic Surgery, Ohio State University Medical Center, Columbus, OH, USA
| | - Kelsey C Mumford
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Sruthi Ilangovan
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Imelda L Vetter
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Steven L Henry
- The University of Texas at Austin Dell Medical School, Austin, TX, USA; Seton Plastic and Hand Surgery, Ascension Medical Group, Austin, TX, USA
| | - Brian P Kelley
- The University of Texas at Austin Dell Medical School, Austin, TX, USA; Seton Plastic and Hand Surgery, Ascension Medical Group, Austin, TX, USA
| | | | - Brent M Egeland
- The University of Texas at Austin Dell Medical School, Austin, TX, USA; Seton Plastic and Hand Surgery, Ascension Medical Group, Austin, TX, USA
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Torresetti M, Andrenelli E, Peltristo B, Zavalloni Y, Capecci M, Ceravolo MG, Di Benedetto G. The Impact of Reduction Mammaplasty on Breast Sensation: A Systematic Review. Aesthet Surg J 2023; 43:NP847-NP854. [PMID: 37462608 DOI: 10.1093/asj/sjad234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
Loss of sensation is one of the most feared complications of breast reduction surgery. Although several techniques have been proposed to maximize sensitivity preservation, the scientific literature still reports contradictory findings. This systematic review aimed to assess whether breast reduction mammaplasty is associated with measurable changes in breast sensation. This review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed (National Institutes of Health, Bethesda, MD), Scopus (Elsevier, Amsterdam, the Netherlands), and Web of Science (Clarivate, Philadelphia, PA) databases were searched for clinical studies investigating breast sensation after breast reduction mammaplasty. The initial search identified 1523 studies of which 22 articles met our specific inclusion criteria. Most of the included studies are consistent in describing only transient sensation decrease or even sensation improvement after surgery compared to the presurgery condition with any approach, except those investigating outcomes after superior or superolateral pedicle reduction mammaplasty. Nevertheless, the overall quality of evidence is low or very low due to the limited availability of randomized controlled trials or controlled studies and the high risk of bias. LEVEL OF EVIDENCE: 4
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Sensory Restoration in Abdominally Based Free Flaps for Breast Reconstruction Using Nerve Allograft. Plast Reconstr Surg 2023; 151:25-33. [PMID: 36194066 DOI: 10.1097/prs.0000000000009773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Neurotization in breast reconstruction can be performed with the aid of nerve grafts and conduits to decrease the tedious dissection and overcome size mismatch. However, there has yet to be a formal analysis of this approach. The goal of this study was to evaluate sensory recovery after neurotized abdominally based free flaps for breast reconstruction using the authors' novel technique and analyze factors that could affect sensory recovery. METHODS A novel technique using processed nerve allograft in combination with a nerve conduit was used. Dynamic and static sensation recovery tests were performed in patients who underwent neurotized or nonneurotized abdominally based free flap reconstructions. Demographics, surgical details, and complications were analyzed. Statistical analyses were performed using chi-square and Mann-Whitney tests. RESULTS Fifty patients (78 breasts) were analyzed: 60 breasts with neurotized reconstruction and 18 breasts without. For patients with more than 12 months of follow-up, the neurotized cohort demonstrated improved dynamic tests compared to the nonneurotized cohort (38 ± 21.69 versus 56.17 ± 20.8, respectively; P = 0.014). Factors associated with decreased sensory return in patients who underwent neurotized reconstruction were diabetes, higher body mass index, skin-sparing mastectomy, higher American Society of Anesthesiologists class, history of radiation therapy, or history of hormonal therapy. CONCLUSIONS This is the first study to report on outcomes of neurotized autologous breast reconstruction using a nerve graft and conduit technique. The authors' approach resulted in improved sensory outcomes compared to those in patients who did not undergo sensory reconstruction. Importantly, factors that can interfere with sensory recovery were identified. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Chou J, Hyland CJ, Kaufman Goldberg T, Broyles JM. Is nerve coaptation associated with improved sensation after microvascular breast reconstruction? A systematic review. Microsurgery 2022. [PMID: 36271757 DOI: 10.1002/micr.30979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 09/16/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sensation after autologous breast reconstruction is an increasingly important outcome. Several studies demonstrated improved sensation with flap neurotization but utilized heterogenous measures and follow-up intervals. This review evaluates sensory outcomes after neurotization using uniform, objective outcome measurements. METHODS PubMed/Medline and Embase databases were queried for articles published between January 1990 and January 2022. Inclusion criteria included studies with free flap tissue transfer breast reconstruction patients and use of Semmes-Weinstein Monofilaments (SWM) to quantify return of sensation after either neurotization or no neurotization. Reviews, case reports, and studies utilizing implants or pedicled flaps were excluded. RESULTS Overall, 513 articles were screened. Eleven articles met inclusion criteria for a total of 474 patients. There were 254 non-neurotized patients included as controls (Group A) and 220 neurotized patients (Group B). Mean follow-up time was similar in both groups (22.06 months vs. 22.78 months, p > 0.05). There was no significant difference in age (Group A = 49.97 years vs. Group B = 42.47 years) or BMI (Group A = 25.48 vs. Group B = 25.97) between groups. More patients in group B received radiation therapy (Group B = 32.72% vs. Group A = 20.86%, p > 0.05). Patients that received neurotization had lower mean pressure thresholds (Group A = 38.85 gm/mm2 vs. Group B = 6.69 gm/mm2 , p = 0.053) than comorbidity-matched controls. CONCLUSION Neurotization has been shown to be a safe and feasible option for enhancing return of sensation after breast reconstruction. Future studies with standardized, long-term follow-up will further elucidate the pattern of breast sensation return and the impact of neurotization.
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Affiliation(s)
- Jesse Chou
- Department of Plastic and Maxillofacial Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Colby J Hyland
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tal Kaufman Goldberg
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin M Broyles
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Payton JI, Abraham JT, Novak MD, Hammonds KP, Altman A. Impact of Patient and Operative Factors on Nipple-Areola Complex Sensation after Bilateral Reduction Mammaplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4353. [PMID: 35673550 PMCID: PMC9162448 DOI: 10.1097/gox.0000000000004353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
Background Alteration of nipple-areola complex (NAC) sensation following reduction mammoplasty is commonly reported and may impact patient satisfaction. The goal of this study was to evaluate the patient and procedural factors that influence the rates of subjective NAC sensation change. Methods A retrospective review of all patients who underwent primary bilateral reduction mammoplasty between January 2014 and August 2018 at the senior author's institution was performed. The primary outcome measured was subjective NAC sensation via digital stimulation of the NAC with the patient reporting sensation as decreased, unchanged, or increased. Results In total, 274 patients met inclusion criteria. NAC sensation was decreased in 19% of breasts, unchanged in 74%, and increased in 7.3%. Patients who underwent vertical pattern, superomedial pedicle reductions were more likely to report a decrease in sensation than those who underwent Wise pattern, inferior pedicle reductions (26% versus 13%; P = 0.0025). Patients with minor complications were more likely to report decreased NAC sensation than those who did not (23% versus 15%; P = 0.0264). The only factor found to be associated with increased sensation was operative time. Conclusions Patients were more likely to report decreased sensation if a vertical skin resection, superomedial pedicle was chosen, or if patients experienced a minor complication. The only factor found to correlate with increased NAC sensation was longer operative times.
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Affiliation(s)
- Jesse I. Payton
- From the Department of Surgery and Division of Plastic Surgery, Baylor Scott & White – Texas A&M University, Temple, Tex
| | - Jasson T. Abraham
- From the Department of Surgery and Division of Plastic Surgery, Baylor Scott & White – Texas A&M University, Temple, Tex
| | - Matthew D. Novak
- From the Department of Surgery and Division of Plastic Surgery, Baylor Scott & White – Texas A&M University, Temple, Tex
| | - Kendall P. Hammonds
- From the Department of Surgery and Division of Plastic Surgery, Baylor Scott & White – Texas A&M University, Temple, Tex
| | - Andrew Altman
- From the Department of Surgery and Division of Plastic Surgery, Baylor Scott & White – Texas A&M University, Temple, Tex
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Lima IGD, Silva JRTD, Silva AGD, Andrade ADS, Sousa LD. Electroacupuncture reduces weight, skinfold thickness and waist circumference and increases skin temperature of the abdominal region in women: a randomized controlled trial. Acupunct Med 2022; 40:425-433. [PMID: 35437025 DOI: 10.1177/09645284221077111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acupuncture, as a complementary and alternative medical treatment, has shown some promise as a therapeutic option for obesity and weight control. The aim of the current study was to investigate the effects of electroacupuncture (EA) on body weight, body mass index (BMI), skin fold thickness, waist circumference and skin temperature of the abdominal region in non-obese women with excessive abdominal subcutaneous fat. METHODS A total of 50 women with excessive abdominal subcutaneous fat (and average BMI of 22) were randomly assigned to one of two groups: an EA group (n = 25) receiving 10 EA sessions (insertion of needles connected to an electrical stimulator at a frequency of 40 Hz for 40 min) and a control group (n = 25) that received no treatment. Outcome measures evaluated included waist circumference, supra-iliac and abdominal skinfolds, body composition and superficial skin temperature (measured by cutaneous thermography) before and after treatment. RESULTS Compared with the untreated group, women in the EA group exhibited decreased supra-iliac and abdominal skin folds (p < 0.001), waist circumference (p < 0.001), percentage body fat (p = 0.001) and percentage abdominal fat (p < 0.001). In addition, the EA group showed an elevated skin temperature at the site of the treatment. However, EA did not significantly impact body weight (p = 0.01) or BMI (p = 0.2). CONCLUSION EA promoted a reduction in abdominal waist circumference, supra-iliac and abdominal skin folds, and percentage body and abdominal fat in women of normal BMI with excessive abdominal subcutaneous fat, as well as an increase in the superficial skin temperature of the abdominal region. TRIAL REGISTRATION NUMBER RBR-9tsmpp (Brazilian Registry of Clinical Trials).
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Affiliation(s)
- Isabella Gomes de Lima
- Physiotherapy Course, Institute of Motricity Sciences, Federal University of Alfenas (UNIFAL), Alfenas, Brazil
| | - Josie Resende Torres da Silva
- Physiotherapy Course, Institute of Motricity Sciences, Federal University of Alfenas (UNIFAL), Alfenas, Brazil.,Program of Biosciences Applied to Health, Federal University of Alfenas, Alfenas, Brazil
| | - Amanda Godoy da Silva
- Program of Rehabilitation Sciences, Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Alice de Sousa Andrade
- Program of Rehabilitation Sciences, Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Ligia de Sousa
- Physiotherapy Course, Institute of Motricity Sciences, Federal University of Alfenas (UNIFAL), Alfenas, Brazil.,Program of Rehabilitation Sciences, Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
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Abdelrehem A, Shi J, Wang X, Wu Z, Mashrah MA, Zhang C, Li S, Zhang C, Wang L. A novel loop neurorrhaphy technique to preserve lower lip sensate in mandibular reconstruction using an innervated vascularized iliac bone flap. Head Neck 2021; 44:46-58. [PMID: 34664349 DOI: 10.1002/hed.26896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/25/2021] [Accepted: 09/30/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study aimed to introduce a novel loop neurorrhaphy technique using an innervated vascularized iliac bone flap (VIBF) with vascularized ilioinguinal nerve (IIN) to reconstruct the inferior alveolar nerve (IAN) and preserve lower lip sensation simultaneously with mandibular reconstruction. METHODS This study prospectively included patients who underwent mandibular reconstruction using VIBF from May 2018 to April 2020. Subjects were allocated into two groups: (1) Group I; innervated VIBF with loop neurorrhaphy (IIN doubly anastomosed with IAN and mental nerve), (2) Group II (control); conventional VIBF. Evaluation was done with operative time, intraoperative indocyanine green (ICG), lower lip sensory assessment (two-point discrimination [TPD] test and current perception threshold [CPT]), and drooling. RESULTS Twelve patients were included; 6 in each group, (7 males and 5 females), age ranging from 18 to 57 years (average: 36.75 years). In all cases, intraoperative perfusion of IIN was confirmed by ICG. Group I showed a statistically significant more flap harvesting time compared with group II (mean difference, 5.67 min; P = 0.0091). There was a significant difference in sensory recovery favoring group I (P < 0.05). The TPD results in group I showed an average of 9.8 ± 6.9 mm and 6.2 ± 5.7 mm on operated and non-operated sides, while Group II showed a poor sensory recovery, and the TPD showed an average of 24.6 ± 6.7 mm and 8.4 ± 2.3 mm on operated and non-operated sides. The CPT results showed a significant difference between both groups. In Group I, the extent of drooling was 3.16 ± 0.75, while in Group II, the score was 1.6 ± 0.81, revealing a significant difference favoring Group I. CONCLUSIONS Concurrent mandibular reconstruction using VIBF and loop neurorrhaphy with vascularized IIN to reconstruct IAN successfully restore lower jaw form and preserve lip sensation.
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Affiliation(s)
- Ahmed Abdelrehem
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China.,Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Jingcun Shi
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xudong Wang
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Ziqian Wu
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Mubarak Ahmed Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chengyao Zhang
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China.,Department of Head and Neck Cancer Center, Chongqing University Cancer Hospital, Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Siyi Li
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Chenping Zhang
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Lei Wang
- Department of Oral and Maxillofacial Surgery - Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, Shanghai, China
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Wang Z, Xuan M, Leng Q, Zhao Q, Li Y, Song P. Evaluation of Postoperative Repair Effect of Oral Tumors Based on Free Ultrasound Flap Transplantation. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this paper, the treatment of oral tumors with free flap transplantation based on ultrasound contrast is studied, and the repair effect is analyzed and evaluated in-depth, the postoperative quality of life of patients with oral malignant tumors is evaluated, and the factors affecting
their quality of life are analyzed. 120 patients with oral malignant tumors were selected. The continuity of the jaws, neck clearance method, clinical stage, tumor recurrence, radiotherapy, and chemotherapy all have varying degrees of impact on the postoperative quality of life. Multivariate
analysis suggests that tumor recurrence has the greatest impact on the quality of life of patients followed by jaw continuity, tumor stage, with or without neck clearance. First, the early detection rate of tumors should be improved, and the tumors should be removed as completely as possible
during the operation to avoid residues. If necessary, cervical lymph node dissection can be performed. Patients with discontinuous jaws should be reconstructed and repaired in time to restore the maxillofacial shape and function of the patients, to greatly reduce the impact on the quality
of life of patients after surgery.
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Affiliation(s)
- Zhanwen Wang
- Department of Ultrasound, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Ming Xuan
- Department of Head and Neck Oncology Surgery, Stomatology College Sichuan University, ChengDu, 610041, China
| | - Qianying Leng
- Department of Ultrasound, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Qin Zhao
- Department of Ultrasound, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Yan Li
- Department of Ultrasound, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
| | - Ping Song
- Department of Ultrasound, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China
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9
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Sensibility, Sensation, and Nerve Regeneration after Reconstructive Genital Surgery: Evolving Concepts in Neurobiology. Plast Reconstr Surg 2021; 147:995e-1003e. [PMID: 34019514 DOI: 10.1097/prs.0000000000007969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sensory recovery following phalloplasty and vaginoplasty for gender dysphoria is essential to the overall success of gender-confirming surgery. Anecdotal evidence suggests that superior reinnervation results are seen in genitoplasty compared to other peripheral nerve repair scenarios. Despite these observed differences, the quality of available literature is poor. METHODS The authors reviewed the body of English language literature regarding sensory outcomes following genitoplasty for gender confirmation. RESULTS The available body of literature discussing the basic science and clinical science aspects of sensory recovery following gender-confirming genitoplasty is small. Available data show that sensory recovery following vaginoplasty produces high rates of reported orgasmic ability, largely through the neoclitoris, and a neovagina with vibratory and pressure sensation similar to that of the native vagina. Phalloplasty sensory outcomes are variable, with the largest series reporting return of sensation in the neophallus that is slightly less than what is measured in control men. Erogenous sensation, including the ability to orgasm, is present in nearly all patients after several months. CONCLUSIONS Existing series indicate that genitoplasty patients experience faster and more complete recovery than any other peripheral nerve regeneration scenarios. However, there are many potential confounding factors in assessment and reporting, and more consistent and reproducible measure endpoints measures are needed. Further research is needed to better understand both the basic science and clinical science of peripheral nerve regeneration in genitoplasty, which may change fundamental aspects of current paradigms of peripheral nerve regeneration.
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Tabrizi R, Neamati M, Rajabloo S, Latifi F. Does the Lag Time Between Injury and Treatment Affect Recovery of Infraorbital Nerve Disturbances in Zygomaticomaxillary Complex Fractures? Craniomaxillofac Trauma Reconstr 2020; 13:105-108. [PMID: 32642040 DOI: 10.1177/1943387520902896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design A cross-sectional study. Objective Neurosensory disturbances (NSDs) of the infraorbital nerve (ION) are common following orbito-zygomaticomaxillary complex (ZMC) fractures. This study aimed to evaluate the effect of lag time between injury and treatment on recovery of NSDs of the ION following open reduction internal fixation. Methods Subjects who had ZMC fracture and paresthesia were studied. The lag time between injury and treatment was considered as the predictive factor. The level of NSDs according to the brush test and two-point discrimination (TPD) test and self-reported NSD were the outcomes of this study. Self-reported NSD was quantified using a visual analog scale. Results Forty patients were studied. The lag time between injury and treatment had a significant correlation with the result of the TPD test and the self-reported level of NSD. In 73.6% of patients who had NSD following ZMC fracture, every 1-day delay in treatment increased the incidence of self-reported paresthesia by 0.44. Conclusions It seems, a delay in treatment of ZMC fractures increased the risk of NSD.
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Affiliation(s)
- Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Neamati
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Rajabloo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Longo B, Timmermans FW, Farcomeni A, Frattaroli JM, D'orsi G, Atzeni M, Sorotos M, Laporta R, Santanelli di Pompeo F. Septum-Based Mammaplasties: Surgical Techniques and Evaluation of Nipple-Areola Sensibility. Aesthetic Plast Surg 2020; 44:689-697. [PMID: 32128706 DOI: 10.1007/s00266-020-01657-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the study was to describe details of surgical techniques and objectively evaluate nipple-areola (NAC) sensibility and viability of septum-based mammaplasties compared to not septum-based reduction techniques. METHODS Data regarding NAC sensibility for static and moving one- and two-point discrimination were prospectively collected from 63 active group hypertrophic-breasted patients undergoing septum-based reduction mammaplasty preoperatively, at 6 and 12 months postoperatively, and from a control group of 60 patients who underwent not septum-based techniques. Fixed and mixed effect models were used for statistical analysis. RESULTS Comparison of complications showed no significant differences between groups (p = 0.07). After adjusting the results of the active group according to type of sensory testing, it emerged that the threshold decreases by 10% (p = 0.0003) at 6 months and even reaches 43% (p < 0.0001) at 12 months. The results have been modulated according to age, since the variation is less marked when age increased, by 0.6% at 6 months and 0.8% at 12 months (p = 0.019). The effects of the BMI can only be seen at 12 months, with an increase by 1.3% per year (p = 0.033). Among septum-based techniques, the inferior-central pedicle showed better sensibility outcomes even if not significantly (p = 0.06). Comparison of NAC sensibility outcomes showed that active group had thresholds that were 48% lower when compared to those of the control group at 12 months postoperatively (p < 0.001). CONCLUSION Septum-based mammaplasty gives optimal results in terms of NAC viability with a significant improvement of sensibility postoperatively. Comparative outcomes on sensibility were also significantly better than not septum-based techniques. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Benedetto Longo
- Division of Plastic and Reconstructive Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy.
| | - Floyd Wilhelmus Timmermans
- Department of Plastic and Reconstructive Surgery, Radboud University Hospital, Nijmegen, The Netherlands
| | - Alessio Farcomeni
- Department of Infectious Diseases and Public Health, School of Medicine and Dentistry, "Sapienza" University of Rome, Rome, Italy
| | - Jacopo Maria Frattaroli
- Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Gennaro D'orsi
- Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Matteo Atzeni
- Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Michail Sorotos
- Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Rosaria Laporta
- Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Division of Plastic Surgery, Sant'Andrea Hospital, NESMOS Department, School of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
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Neubauer T, Brand J, Hartmann A. Neurovaskuläre Komplikationen bei Frakturen der Extremitäten, Teil 2. Unfallchirurg 2020; 123:225-237. [DOI: 10.1007/s00113-020-00768-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rinkel WD, Rizopoulos D, Aziz MH, Van Neck JW, Cabezas MC, Coert JH. Grading the loss of sensation in diabetic patients: A psychometric evaluation of the rotterdam diabetic foot study test battery. Muscle Nerve 2018; 58:559-565. [PMID: 30028522 PMCID: PMC6646912 DOI: 10.1002/mus.26192] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 12/22/2022]
Abstract
Introduction: Static‐ and moving 2‐point discrimination (S2PD, M2PD), 10‐g monofilaments‐ and tuning fork are validated outcome measures of clinical manifestations of diabetes‐related neuropathy. No modern statistical techniques have been used to investigate how well these instruments combine to measure sensory loss. Methods: To grade sensory loss at the feet, we fitted parametric forms of Item Response Theory models to the data of these instruments. Results: The fit statistics indicate that the loss of sensation is gradable, with readily available instruments. S2PD and M2PD are lost first, followed by vibration sense, the 10‐g monofilament and the ability to feel a cold stimulus. Conclusions: This test battery appears to provide sound measurement properties in a group of diabetic patients with diverse amounts of sensory loss. This approach may be used in clinical practice to grade sensory loss reliably and quickly, with instruments that are easy to use. Muscle Nerve58: 559–565, 2018
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Affiliation(s)
- Willem D Rinkel
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Utrecht University Medical Center, Utrecht, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC - University Medical Center, Rotterdam, the Netherlands
| | - M Hosein Aziz
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands
| | - Johan W Van Neck
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine/Centre for Diabetes, Endocrinology and Vascular Medicine, Franciscus Gasthuis, Rotterdam, the Netherlands
| | - J Henk Coert
- Erasmus MC - University Medical Center, Department of Plastic-, Reconstructive-, and Hand Surgery, Room Ee 15.91, Box 2040, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands.,Department of Plastic-, Reconstructive-, and Hand Surgery, Utrecht University Medical Center, Utrecht, the Netherlands
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