Sural Nerve Graft Donor-Site Morbidity in Nipple-Areola Complex Sensory Reinnervation: A Prospective Cohort Study.
7 affiliations
- 1Department of Doctoral Studies, Rīga Stradiņš University, LV-1007 Riga, Latvia.
- 2Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, LV-1002 Riga, Latvia.
- 3Universitätsklinikum Gießen (UKGM), Klinikstraße 33, 35392 Gießen, Germany.
- 4Faculty of Medicine, Rīga Stradiņš University, LV-1007 Riga, Latvia.
- 5Department of Pediatric Surgery, Children's Clinical University Hospital, LV-1004 Riga, Latvia.
- 6Institute of Oncology and Molecular Genetics, Rīga Stradiņš University, LV-1007 Riga, Latvia.
- 7Department of Surgery, Rīga Stradiņš University, LV-1007 Riga, Latvia.
Abstract
Background and Objectives: Sural nerve grafts are increasingly used to restore sensation after reconstructive surgery, including nipple-areola complex (NAC) reinnervation following nipple-sparing mastectomy, but donor-site morbidity has not been characterized using combined objective and patient-reported measures. We quantified this morbidity prospectively. Materials and Methods: Ten women who had undergone mastectomy with direct-to-implant reconstruction and NAC reinnervation using a sural nerve graft were assessed by photographic mapping of the donor-site deficit, the FootQ symptom and scar-satisfaction questionnaire (preoperatively, 6 months, 1 year), sural nerve conduction studies (NCS) at 12 months (at 10 months in one patient), and bedside Semmes-Weinstein monofilament and two-point discrimination (2PD) testing. Spearman correlation, Wilcoxon signed-rank, and Friedman tests were used. Results: Harvest length and deficit area were not significantly associated (ρ = -0.588, p = 0.074; bootstrap 95% CI -0.90 to +0.08); with ten patients, the analysis was underpowered and neither establishes nor excludes an association. Deficit area was strikingly variable (coefficient of variation 56%) and did not differ by neurotoxic chemotherapy exposure (five per subgroup). At 1 year, seven of nine patients (78%) had an unrecordable sural sensory action potential, yet monofilament thresholds were normal in every evaluable patient, and 2PD did not differ between limbs. FootQ symptoms increased from the preoperative assessment to 6 months (composite 1.34 to 2.19; p = 0.047), then remained mild and unchanged to 1 year (all p ≥ 0.50); scar satisfaction remained high. Conclusions: Sural graft harvest produces a highly variable and often electrophysiologically persistent donor-site sensory deficit that bedside testing and patient-reported outcomes did not detect at 1 year; because those tests used fixed anatomical sites, the discordance may reflect the territory assessed as much as test sensitivity or peripheral compensation. This small cohort neither establishes nor excludes an association between harvest length and the residual deficit, and the donor site remained clinically well tolerated.
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BibTeX
@article{lapiņs2026sural,
title = {{Sural Nerve Graft Donor-Site Morbidity in Nipple-Areola Complex Sensory Reinnervation: A Prospective Cohort Study.}},
author = {Jānis Lapiņš and Beatriz Soares Domingues Polita and Linda Kalniņa and Michal Grucki and Dzintars Ozols and Ansis Ģīlis and Arvīds Irmejs and Kristaps Blūms and Gundega Ķauķe and Jānis Gardovskis and Jeļena Maksimenko},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = sep,
doi = {10.3390/medicina62101864},
url = {https://europepmc.org/article/MED/42942395},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sural Nerve Graft Donor-Site Morbidity in Nipple-Areola Complex Sensory Reinnervation: A Prospective Cohort Study.
AU - Jānis Lapiņš
AU - Beatriz Soares Domingues Polita
AU - Linda Kalniņa
AU - Michal Grucki
AU - Dzintars Ozols
AU - Ansis Ģīlis
AU - Arvīds Irmejs
AU - Kristaps Blūms
AU - Gundega Ķauķe
AU - Jānis Gardovskis
AU - Jeļena Maksimenko
PY - 2026
DA - 2026/09/26
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62101864
UR - https://europepmc.org/article/MED/42942395
AB - Background and Objectives: Sural nerve grafts are increasingly used to restore sensation after reconstructive surgery, including nipple-areola complex (NAC) reinnervation following nipple-sparing mastectomy, but donor-site morbidity has not been characterized using combined objective and patient-reported measures. We quantified this morbidity prospectively. Materials and Methods: Ten women who had undergone mastectomy with direct-to-implant reconstruction and NAC reinnervation using a sural nerve graft were assessed by photographic mapping of the donor-site deficit, the FootQ symptom and scar-satisfaction questionnaire (preoperatively, 6 months, 1 year), sural nerve conduction studies (NCS) at 12 months (at 10 months in one patient), and bedside Semmes-Weinstein monofilament and two-point discrimination (2PD) testing. Spearman correlation, Wilcoxon signed-rank, and Friedman tests were used. Results: Harvest length and deficit area were not significantly associated (ρ = -0.588, p = 0.074; bootstrap 95% CI -0.90 to +0.08); with ten patients, the analysis was underpowered and neither establishes nor excludes an association. Deficit area was strikingly variable (coefficient of variation 56%) and did not differ by neurotoxic chemotherapy exposure (five per subgroup). At 1 year, seven of nine patients (78%) had an unrecordable sural sensory action potential, yet monofilament thresholds were normal in every evaluable patient, and 2PD did not differ between limbs. FootQ symptoms increased from the preoperative assessment to 6 months (composite 1.34 to 2.19; p = 0.047), then remained mild and unchanged to 1 year (all p ≥ 0.50); scar satisfaction remained high. Conclusions: Sural graft harvest produces a highly variable and often electrophysiologically persistent donor-site sensory deficit that bedside testing and patient-reported outcomes did not detect at 1 year; because those tests used fixed anatomical sites, the discordance may reflect the territory assessed as much as test sensitivity or peripheral compensation. This small cohort neither establishes nor excludes an association between harvest length and the residual deficit, and the donor site remained clinically well tolerated.
SN - 1010-660X
SN - 1648-9144
ER -