A carregar...
Publicação
Neuroanatomia do retalho baseado em vasos perfurantes da artéria epigástrica inferior profunda e o seu impacto na reconstrução mamária com sensibilidade
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1007.54 KB | Adobe PDF |
Orientador(es)
Resumo(s)
O retalho baseado nos vasos epigástricos profundos inferiores (DIEP) é gold standard para a reconstrução mamária autóloga em diversos centros cirúrgicos. A recuperação da sensibilidade mamária após a reconstrução é fundamental para aumentar a satisfação das pacientes e prevenir queimaduras ou outras lesões que podem resultar da ausência ou diminuição da sensibilidade após a mastectomia. Alguns estudos na literatura apontam para a ocorrência de alguma recuperação espontânea da sensibilidade após reconstrução com o retalho DIEP não neurotizado. No entanto, esta recuperação é lenta e imprevisível. Por outro lado, existe também evidência científica de que a neurotização do retalho DIEP está associada a um retorno mais célere, mais previsível e mais completo da sensibilidade. Apesar desta evidência, na maioria dos centros, continua a não se realizar neurotização do retalho. As descrições anatómicas atuais dos nervos que inervam o retalho DIEP têm sido inconsistentes na literatura. Este trabalho tem como objetivo fornecer um resumo conciso de conhecimento atual sobre a neuroanatomia do retalho DIEP de modo a disponibilizar aos cirurgiões armas teóricas que permitam realizar reconstrução mamária com uma maior recuperação da sensibilidade. Foi realizada uma revisão narrativa da literatura com base na consulta de bases de dados da literatura biomédica, como a PubMed, Up To Date e Google Scholar. Os artigos foram selecionados com base na sua relevância e o nível evidência. O retalho DIEP é inervado pelos ramos cutâneos terminais, anteriores e laterais, do décimo ao décimo segundo nervos intercostais. No entanto, informações sobre trajeto, distribuição e ramificações destes nervos encontram-se descritas de forma heterogénea na literatura. Acreditamos que uma melhor clarificação da neuroanatomia envolvida no retalho de DIEP pode contribuir para que um maior número de cirurgiões plásticos incorpore o passo cirúrgico da neurotização na sua rotina reconstrutiva, com benefício terapêutico reconhecido para as pacientes.
The Deep Inferior Epigastric Artery Perforator flap (DIEP flap) is gold standard for autologous breast reconstruction at several institutions. The recovery of breast sensitivity after reconstruction is essential to increase patient satisfaction and prevent burns or other injuries that may result from the absence or reduction of sensitivity after mastectomy. Some studies in the literature point to the occurrence of some spontaneous recovery of sensitivity after reconstruction with the non-neurotized DIEP flap. However, this recovery is slow and unpredictable. On the other hand, there is also scientific evidence that the neurotization of the DIEP flap is associated with a faster, more predictable, and more complete return of sensation. Despite this evidence, neurotization of the flap is still not performed in most centers. Current anatomical descriptions of the nerves that innervate the DIEP flap have been inconsistent in the literature. This study aims to provide a concise summary of current knowledge on the neuroanatomy of the DIEP flap to provide surgeons with theoretical weapons to perform breast reconstruction with greater recovery of sensitivity. A narrative literature review was carried out by consulting biomedical literature databases such as PubMed, Up To Date, and Google Scholar. Articles were selected based on their relevance and level of evidence. The DIEP flap is innervated by the terminal, anterior, and lateral cutaneous branches of the tenth to twelfth intercostal nerves. However, information on the path, distribution, and ramifications of these nerves is heterogeneously described in the literature. We believe that better clarification of the neuroanatomy involved in the DIEP flap could help more plastic surgeons incorporate the surgical step of neurotization into their reconstructive routine, with recognized therapeutic benefits for patients.
The Deep Inferior Epigastric Artery Perforator flap (DIEP flap) is gold standard for autologous breast reconstruction at several institutions. The recovery of breast sensitivity after reconstruction is essential to increase patient satisfaction and prevent burns or other injuries that may result from the absence or reduction of sensitivity after mastectomy. Some studies in the literature point to the occurrence of some spontaneous recovery of sensitivity after reconstruction with the non-neurotized DIEP flap. However, this recovery is slow and unpredictable. On the other hand, there is also scientific evidence that the neurotization of the DIEP flap is associated with a faster, more predictable, and more complete return of sensation. Despite this evidence, neurotization of the flap is still not performed in most centers. Current anatomical descriptions of the nerves that innervate the DIEP flap have been inconsistent in the literature. This study aims to provide a concise summary of current knowledge on the neuroanatomy of the DIEP flap to provide surgeons with theoretical weapons to perform breast reconstruction with greater recovery of sensitivity. A narrative literature review was carried out by consulting biomedical literature databases such as PubMed, Up To Date, and Google Scholar. Articles were selected based on their relevance and level of evidence. The DIEP flap is innervated by the terminal, anterior, and lateral cutaneous branches of the tenth to twelfth intercostal nerves. However, information on the path, distribution, and ramifications of these nerves is heterogeneously described in the literature. We believe that better clarification of the neuroanatomy involved in the DIEP flap could help more plastic surgeons incorporate the surgical step of neurotization into their reconstructive routine, with recognized therapeutic benefits for patients.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
DIEP flap DIEP innervation DIEP nerves DIEP sensation Deep Inferior Epigastric Artery Perforator (DIEP)