SENSITIVE INNERVATION OF MICROSURGICAL FLAPS WHICH ARE USED IN RECONSTRUCTIVE MAMMOPLASTY

Afferent denervation of the skin at free microsurgical flaps and directed afferent reinnervation is significancequestion in surgery. This is due to the increasing demands (by patients) to reconstructive mammoplasty. Therewas also a need to improve methods of reconstruction with the mandatory restoration of skin sensitivity of thereconstructed breast. The purpose of this work: a review of available information on the afferent innervation of the skin of the human body in zones of rising microsurgical flaps wich commonly used for breast reconstruction . Material and methods: the data used classical anatomical studies on sensory innervation of human skin inplaces of microsurgical flaps for reconstructive mammoplasty . Results. We propose the concept of afferent innervation of microsurgical flaps used in reconstructive mammoplasty. We apply two levels of afferent innervation: dermatomal (1) and axial (2). According to this concept, in the thoraco-dorsal flap (TDF) dermatomal level of afferent innervation of the skin is the posterior branch of IV- VIII intercostal nerves and the axial - afferent filaments of thoracodorsal nerve. In DIEP-flap (deep inferiorepigastric perforator flap), as well as TRAM-flap (transverse rectus abdominis myocutaneous flap), dermatomallevel of afferent innervation is provided by anterior and lateral branches of the X-XII intercostal nerves. Axiallevel of innervation is unknown. At TMG-flap (transverse myocutaneous gracilis flap) dermatomal level provided by ilioinguinal nerve, axial-sensitive branch of the obturator nerve , running as part of the dominant proximal vascular pedicle of that kind of flap. In SGAP-flap (superior gluteal artery perforator flap) dermatomal levelof afferent innervation of the skin provided by nervi clunii superioris, axial - has not been studied

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