Anatomic features of intercostal nerves with relation to TRAM and DIEP breast reconstruction / 中华医学美学美容杂志

ABSTRACT

Objective To supply anatomic foundation for TRAM and DIEP flaps breast reconstruction with both sensory innervation and rectus abdominis muscle function preserved. Methods Dissections of T8～T12 nerves in anterior abdominal wall were performed on 9 embalmed female cadavers (18 sides). By reconstructing DIEP flaps in 15 cases, the natures of the intercostal nerves and the relations with deep inferior epigastric perforators were investigated. Results Most intercostal nerves pierced the rectus abdominis muscle in the lateral one third. There were interconnections between muscular branches of segmental nerves. Sensory branches traveling with vascular perforators were divided into medial branch and lateral branch. The mean length of pure sensory nerve was (27.6?12.2)mm. Conclusion It is possible to preserve sensory innervation by coapting lower intercostal nerves to the 4th thoracic nerve in TRAM and DIEP breast reconstruction. Sparing lateral one third of rectus abdominis muscle does not cause denervated atrophy in the rectus abdominis muscle after TRAM breast reconstruction.