Prevention of perioperative limb neuropathies in abdominal free flap breast reconstruction * Adam Blackburn a , Rieka Taghizadeh a , David Hughes b , Joseph M. O’Donoghue a, * a Department of Plastic Surgery, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom b Department of Anaesthesia, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle Upon Tyne, NE1 4LP, United Kingdom Received 26 October 2014; accepted 24 September 2015 KEYWORDS Breast reconstruction; Free flaps; Microsurgery; Neuropathy Summary Background and aims: Perioperative peripheral neuropathies are a significant cause of post-operative morbidity in patients undergoing prolonged procedures. The aims of this study were to determine the incidence and possible causes of peripheral neuropathy in patients undergoing abdominal free flap breast reconstruction and to develop methods of ameliorating this problem. Methods: A 4-year retrospective study of patients undergoing abdominal free flap breast reconstruction by a single surgeon and anaesthetist was undertaken to determine the inci- dence and potential causes of perioperative neuropathy. A new positioning protocol was intro- duced to minimise the stretch on the brachial plexus and to protect peripheral nerves from compression forces. In addition, regular intraoperative physiotherapy was introduced. A prospective study was then conducted on patients managed by the same team to evaluate the effect of this change in practice on the subsequent incidence of peripheral neuropathies. Results: Over the 4-year retrospective period, 93 consecutive patients underwent abdominal free flap breast reconstruction, six of whom (6.5%) developed a peripheral neuropathy. Following the introduction of the new positioning protocol, prospective data collected on 65 consecutive patients showed no further occurrences of perioperative neuropathy (p Z 0.04). There were no significant differences in the characteristics between the two co- horts. * Presentation: BAPRAS Winter Scientific Meeting, London, UK, November 30th 2011. * Corresponding author. Tel.: þ44 (0) 1912820496. E-mail address: joe.o’donoghue@nuth.nhs.uk (J.M. O’Donoghue). + MODEL Please cite this article in press as: Blackburn A, et al., Prevention of perioperative limb neuropathies in abdominal free flap breast reconstruction, Journal of Plastic, Reconstructive & Aesthetic Surgery (2015), http://dx.doi.org/10.1016/j.bjps.2015.09.015 http://dx.doi.org/10.1016/j.bjps.2015.09.015 1748-6815/ª 2015 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. Journal of Plastic, Reconstructive & Aesthetic Surgery (2015) xx,1e7