Use of the anterior cutaneous branch of the third inter costal nerve to reinnervate the DIEP flap

Abstract

Today, the DIEP flap (deep inferior epigastric artery perforator flap) is becoming the most popular method of breast reconstruction after mastectomy. The next step in the evolution of this flap should be to improve its sensitivity in the postoperative period. Recovery of sensitivity in the reconstructed mammary gland improves the quality of life of patients, as well as restores the protective function of the skin. In addition, tactile sensitivity of the breast plays a very important role in the intimate life of women. However, the question of finding and isolating the recipient nerve for the purpose of reinnervation of the flap remains open. This fact was the reason for the search for the optimal surgical technique for this stage of the operation. The world literature describes some ways of reinnervation of the DIEP-flap (flap on the perforators of the deep inferior epigastric artery). All of them have their pros and cons. We propose to use the anterior cutaneous branch of the 3rd intercostal nerve as a recipient, which is located in the same microsurgical field as the internal thoracic vessels. This method, in our opinion, allows you to minimize the time to search for and isolate the recipient nerve.