Spontana osjetna reinervacija nakon rekonstrukcije dojke slobodnim režnjevima

master's thesis

• Title (english): Spontaneous sensory reinnervation following free flap breast reconstruction
• Author: Jana Leskovar
• Mentor: Krešimir Bulić (mentor)
• Committee member: Davor Mijatović (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Krešimir Bulić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Rekonstrukcija dojke vlastitim tkivom sve je prihvaćenija sastavnica procesa liječenja žena oboljelih od karcinoma dojke nakon mastektomije. Brojni su istraživači dokazali spontani povravak osjeta u koži rekonstruirane dojke, no njegov doseg se u neinerviranim režnjevima smatra varijabilnim i nepredvidljivim. Osjet u dojci pokazao se važnom odrednicom postoperativne kvalitete života pacijentica.
Svrha našeg istraživanja je subjektivno i objektivno istražiti oporavak osjeta nakon rekonstrukcije dojke slobodnim mikrovaskularnim TRAM i DIEP režnjevima. Istraživanju se odazvalo 19 pacijentica kojima je dojka unazad 5 godina rekonstruirana na Zavodu za plastično-rekonstruktivnu kirurgiju i kirugiju dojke KBC-a Zagreb. Osjet dodira kvantitativno je mjeren Semmes-Weinstein monofilamentima, a osjeti toplog i hladnog određivani su kvalitativno. Pozornost je usmjerna na oporavak osjeta isključivo u otoku kože slobodnog režnja.
Glavni mehanizam spontane reinervacije je aksonalna regeneracija iz presječenih živaca primajuće lože prsišta, dok regenerativno nicanje iz rubova okolne kože varijabilno doprinosi oporavku osjeta. TRAM režanj zbog prisutnosti mišićne sastavnice ima manji kapacitet za osjetnu reinervaciju mehanizmom aksonalne regeneracije putem živaca iz primajuće lože prsišta u odnosu na DIEP režanj. Imunoterapija trastuzumabom pridonosi ranijem i opsežnijem oporavku osjeta dodira.
Među ispitivanim modalitetima u najvećeg broja ispitanica vratio se osjet dodira. Najbolji stupanj oporavka osjeta dodira postignut je u superomedijalnom području otoka kože TRAM režnja. U inferiornim područjima otoka kože TRAM režnja osjeti dodira, toplog i hladnog najprije su se pojavili te su se oporavili u najvećeg broja ispitanica. Najranija pojava objektivno mjerljivog osjeta dodira zabilježena je 5 mjeseci od rekonstrukcije TRAM i DIEP režnjem.

Abstract (english)

Autologous breast reconstruction is becoming an integral part of the breast cancer treatment including mastectomy. Numerous researchers have recorded spontaneous recovery of sensation in the skin of reconstructed breasts, but its extent in noninnervated flaps seems to be variable and unpredictable. Breast sensation has a considerable effect on postoperative quality of life.
The purpuse of our study was to subjectively and objectively examine the recovery of sensation after TRAM and DIEP free flap microvascular reconstruction. 19 patients who had their breast reconstructed in the last 5 years at Department of Plastic, Reconstructive and Cosmetic Surgery, University Hospital Center Zagreb agreed to participate. Touch sensation was measured quantitatively using Semmes-Weinstein monofilaments, cold and warm were assessed qualitatively. We focused on the recovery of sensation in the exposed skin island of the flap.
The major mechanism of spontaneous reinnervation appears to be axonal regeneration of transected nerves from the recipient bed, whereas regenerative sprouting from adjacent skin margins seems to be less consistent. According to its muscle component TRAM flap has the lower capacity of sensory reinnervation by mechanism of axonal regeneration from recipient bed compared to DIEP flap. Trastuzumab immunotherapy was demonstrated to contribute to earlier and more extensive recovery of touch sensation.
Among the tested sensory modalities, touch was the best recovered sensation. The highest level of touch sensation was achieved in superomedial part of the TRAM flap skin island. In inferior areas of TRAM flap skin island all sensory modalities appeared first and regenerated in the greatest number of patients. The earliest objectively measurable touch sensation was recorded 5 months after the reconstruction with TRAM and DIEP flap.

• Keywords: oporavak osjeta; osjetna reinervacija; periferni živac; rekonstrukcija dojke; slobodni režanj
• Keywords (english): breast reconstruction; free flap; peripheral nerve; sensory recovery; sensory reinnervation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:605788
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access; Embargo expiration date: 2020-10-15
• Created on: 2020-03-10 11:43:00