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Jaiswal D, Mathews S, Gupta H, Shankhdhar VK, Mantri M, Bindu A, Pilania V, Yadav P. Utilizing the Retrograde Flow of Internal Mammary Vessels as a Donor Pedicle. Indian J Plast Surg 2022; 55:244-250. [PMID: 36325086 PMCID: PMC9622219 DOI: 10.1055/s-0042-1750377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction
The aim of this study is to assess the results of retrograde flow of internal mammary artery and vein (IMA/V) as a donor vessel for free flap microvascular anastomosis (MVA). This need arises with bipedicle deep inferior epigastric perforator (DIEP) flaps, when all four zones with extra fat need to be harvested for unilateral breast reconstruction coupled with poor midline crossover of circulation naturally or because of midline scar. Large anterolateral thigh flaps for chest wall cover, with multiple perforators from separate pedicles, also need supercharging. This needs an additional source of donor vessels, antegrade IMA/V being the first one.
Materials and Methods
Retrospective study of microvascular breast reconstruction using retrograde internal mammary donor vessels.
Results
Out of 35 cases, 20 cases had distal IMA/V, with retrograde flow, as donor vessel for second set of arterial and venous anastomosis. In two cases, retrograde IMA/V was used for the solitary set of MVA. In remaining 13 cases, either retrograde IMA or V was utilized either as a principal or accessory donor. No flap was lost. Venous and arterial insufficiency happened in one case each, both were salvaged. Two cases developed partial necrosis, needing debridement and suturing. One case developed marginal necrosis. Only one case developed fat necrosis with superadded infection on follow-up.
Conclusion
Distal end of IMA and IMV on retrograde flow is safe for MVA as an additional or sole pedicle. It is convenient to use being in the same field. It enables preservation of other including thoracodorsal pedicle and latissimus dorsi flap for use in case of a complication or recurrence.
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Affiliation(s)
- Dushyant Jaiswal
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Saumya Mathews
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Himanshu Gupta
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vinay Kant Shankhdhar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mayur Mantri
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ameya Bindu
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vineet Pilania
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prabha Yadav
- Department of Plastic and Reconstructive Surgery, H. N. Reliance Hospital, Mumbai, Maharashtra, India
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Kubota Y, Yamaji Y, Kosaka K, Tokumoto H, Tezuka T, Akita S, Kuriyama M, Mitsukawa N. Internal Mammary Vein Valves: A Histological Study. Sci Rep 2020; 10:8857. [PMID: 32483308 PMCID: PMC7264173 DOI: 10.1038/s41598-020-65810-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/11/2020] [Indexed: 11/09/2022] Open
Abstract
It is widely accepted that the internal mammary vein (IMV) is valveless. However, few anatomical studies are available on the presence or absence of IMV valves. To test the hypothesis that the IMV is valveless, we performed microscopic histological examination of the IMV. IMV samples were collected from 10 human fresh frozen cadavers. For a control, the small saphenous vein (SSV) was obtained. Histological stains were performed. Microscopic examination showed that a venous valve was found in 8 of 20 IMVs. The structure of the valve leaflet consisted of two parts. There was a “thick part” located near the wall of the vein that consisted of smooth muscle cells and fibers. There was also a “thin part” located near the center of the venous lumen that lacked smooth muscle cells. The size of the thick part of the IMV valve was smaller than the SSV valve, whereas there was no difference in the size of the thin part between the IMV and SSV. IMV valves exist. Our results that an IMV valve was present in less than half of IMVs and there was a small-sized valve leaflet suggest that the IMV valve may be rudimentary.
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Affiliation(s)
- Yoshitaka Kubota
- Department of Plastic Surgery, Chiba University 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677, Japan.
| | - Yoshihisa Yamaji
- Department of Plastic Surgery, Maebashi Red Cross Hospital 389-1, Asakura-cho, Maebashi-city, Gunma, #371-0811, Japan
| | - Kentaro Kosaka
- Department of Plastic Surgery, Chiba University 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677, Japan
| | - Hideki Tokumoto
- Department of Plastic Surgery, Chiba Cancer Center 666-2, Nitona-cho, Chuo-ku, Chiba-city, Chiba, #260-8717, Japan
| | - Takafumi Tezuka
- Department of Plastic Surgery, Chiba University 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677, Japan
| | - Shinsuke Akita
- Department of Plastic Surgery, Chiba University 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677, Japan
| | - Motone Kuriyama
- Department of Plastic Surgery, Shin-Yurigaoka General Hospital 255, Aza-Tsuko, Furusawa, Asao-ku, Kawasaki-city, Kanagawa, #215-0026, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic Surgery, Chiba University 1-8-1, Inohana, Chuo-ku, Chiba-city, Chiba, #260-8677, Japan
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Revisiting Anastomosis to the Retrograde Internal Mammary System in Stacked Free Flap Breast Reconstruction. Plast Reconstr Surg 2020; 145:880-887. [DOI: 10.1097/prs.0000000000006712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Steiner D, Horch RE, Ludolph I, Schmitz M, Beier JP, Arkudas A. Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital-A Standardized and Safe Procedure. Front Oncol 2020; 10:177. [PMID: 32195171 PMCID: PMC7066123 DOI: 10.3389/fonc.2020.00177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/31/2020] [Indexed: 01/30/2023] Open
Abstract
Background: Breast cancer is the most common malignancy in women. The interdisciplinary treatment is based on the histological tumor type, the TNM classification, and the patient's wishes. Following tumor resection and (neo-) adjuvant therapy strategies, breast reconstruction represents the final step in the individual interdisciplinary treatment plan. Although manifold flaps have been described, abdominal free flaps, such as the deep inferior epigastric artery perforator (DIEP) or the muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) flap, are the current gold standard for autologous breast reconstruction. This retrospective study focuses on the safety of autologous breast reconstruction upon mastectomy using abdominal free flaps. Methods: From April 2012 until December 2018, 193 women received 217 abdominal free flaps for autologous breast reconstruction at the University Hospital of Erlangen. For perforator mapping, we performed computed tomography angiography (CTA). Venous anastomosis was standardized using a ring pin coupler system, and flap perfusion was assessed with fluorescence angiography. A retrospective analysis was performed based on medical records, the surgery report, and follow-up of outpatient course. Results: In most cases, autologous breast reconstruction was performed as a secondary reconstructive procedure after mastectomy and radiotherapy. In total, 132 ms1-TRAM, 23 ms2-TRAM, and 62 DIEP flaps were performed with 21 major complications (10%) during hospital stay including five free flap losses (2.3%). In all cases of free flap loss, we found an arterial thrombosis as the main cause. In 24 patients a bilateral breast reconstruction was performed without free flap loss. The majority of free flaps (96.7%) did not need additional supercharging or turbocharging to improve venous outflow. Median venous coupler size was 2.5 mm (range, 1.5-3.5 mm). Conclusion: Using CTA, intraoperative fluorescence angiography, titanized hernia meshes for rectus sheath reconstruction, and venous coupler systems, autologous breast reconstruction with DIEP or ms-TRAM free flaps is a safe and standardized procedure in high-volume microsurgery centers.
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Affiliation(s)
- Dominik Steiner
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Marweh Schmitz
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
| | - Justus P Beier
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany.,Department of Plastic Surgery, Hand Surgery, Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander University of Erlangen-Nuernberg, Erlangen, Germany
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Steiner D, Horch RE, Ludolph I, Arkudas A. Successful free flap salvage upon venous congestion in bilateral breast reconstruction using a venous cross-over bypass: A case report. Microsurgery 2019; 40:74-78. [PMID: 30693558 PMCID: PMC7003917 DOI: 10.1002/micr.30423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/11/2018] [Accepted: 12/27/2018] [Indexed: 11/06/2022]
Abstract
Abdominal free flaps such as the muscle sparing transverse rectus abdominis myocutaneous (ms-TRAM) or deep inferior epigastric artery perforator (DIEP) flap represent the gold standard in autologous breast reconstruction. We describe a salvage procedure during bilateral free flap breast reconstruction due to insufficient venous drainage using a venous cross-over bypass. A 54-year-old woman with a thrombosis of the left subclavian port-system in the medical history was elected for simultaneous bilateral breast reconstruction with ms-TRAM and DIEP flaps. Intraoperatively, a venous congestion of the DIEP flap, which was connected to the left cranial internal mammary vessels, appeared. In the absence of sufficient ipsilateral venous recipient vessels, we performed a salvage procedure requiring a 15 cm small saphenous vein graft and presternal subcutaneous tunneling. The flap vein was anastomosed end-to-end with the contralateral caudal internal mammary vein using a coupler system. The postoperative course was uneventful and both flaps survived. We describe the cross-over venous emergency bypass as a useful tool in unexpected venous thrombosis during bilateral free flap breast reconstruction.
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Affiliation(s)
- Dominik Steiner
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ingo Ludolph
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Ho OA, Lin YL, Pappalardo M, Cheng MH. Nipple-sparing mastectomy and breast reconstruction with a deep inferior epigastric perforator flap using thoracodorsal recipient vessels and a low lateral incision. J Surg Oncol 2018; 118:621-629. [PMID: 30212598 DOI: 10.1002/jso.25204] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/23/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy poses challenges in providing esthetically-pleasing immediate autologous breast reconstruction. This study was to investigate the outcomes of nipple-sparing mastectomy with breast reconstruction using free abdominal flaps between two different recipient sites. METHODS Between 2010 and 2016, 79 patients who underwent nipple-sparing mastectomy with autologous breast reconstruction using thoracodorsal (TD) vessels in 30 cases or internal mammary (IM) vessels in 49 cases were investigated. Demographics, intraoperative findings, complications, and quality of life using Breast-Q questionnaire were compared between two groups. RESULTS All flap survived. There was no statistical difference in age, BMI, ischemia time, and flap-used percentage. The TD artery had a statistically smaller diameter 1.8 ± 0.4 mm than the IM artery 2.7 ± 0.43 mm (p = 0.02). At a mean follow-up of 44.4 ± 35.2 months, there was no statistical difference in total complication rates between TD and IM groups (23.3% and 36.7%, respectively, p > 0.05). The "psychosocial well-being" of Breast-Q in TD group 83.9 ± 14.6 was statistically greater than IM group 72.8 ± 17.6 (p = 0.04). CONCLUSIONS Nipple-sparing mastectomy with immediate breast reconstruction using TD vessels with a low lateral scar is a safe procedure that provides an inconspicuous scar with better cosmesis and minimal complication rate.
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Affiliation(s)
- Olivia A Ho
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yi-Ling Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Marco Pappalardo
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
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Rothfuss MA, Franconi NG, Star A, Akcakaya M, Gimbel ML, Sejdic E. Automatic Early-Onset Free Flap Failure Detection for Implantable Biomedical Devices. IEEE Trans Biomed Eng 2018; 65:2290-2297. [PMID: 29993495 DOI: 10.1109/tbme.2018.2793763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Up to 10% of free flap cases are compromised, and without prompt intervention, amputation and even death can occur. Hourly monitoring improves salvage rates, but the gold standard for monitoring requires experienced personnel to operate and suffers from high false-positive rates as high as 31% that result in costly and unnecessary surgeries. In this paper, we investigate free flap patency monitoring using automatic hardware-only classification systems that eliminate the need for experienced personnel. The expected flow ranges of the antegrade and retrograde veins for breast reconstruction are studied using a syringe pump to create the laminar flow seen in veins. METHODS Feature data extracted from the Doppler blood flow signals are analyzed for sensitivity, specificity, and false-positive rates. Hardware is built to perform the classification automatically in real-time and output a decision at the end of the observation period. RESULTS Experimental results using the hardware-only classifier for a 50 ms window size show high sensitivity (96.75%), specificity (90.20%), and low false-positive rate (9.803%). The experimental and theoretical classification results show close agreement. CONCLUSION This work indicates that automatic hardware-only classifiers can eliminate the need for experienced personnel to monitor free flap patency. SIGNIFICANCE The hardware-only classification is amenable to a monolithic implementation and future studies should study a totally implantable wirelessly-powered blood flow classifier. The high classifier performance in a short window period indicates that duty-cycled powering can be used to extend the safe operational depth of an implant. This is particularly relevant for the difficult buried free flap applications.
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8
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Studying the blood pressures of antegrade and retrograde internal mammary vessels: Do they really work as recipient vessels? J Plast Reconstr Aesthet Surg 2017; 70:1391-1396. [DOI: 10.1016/j.bjps.2017.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/10/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
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9
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Vijayasekaran A, Mohan AT, Zhu L, Sharaf B, Saint-Cyr M. Anastomosis of the Superficial Inferior Epigastric Vein to the Internal Mammary Vein to Augment Deep Inferior Artery Perforator Flaps. Clin Plast Surg 2017; 44:361-369. [PMID: 28340668 DOI: 10.1016/j.cps.2016.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Use of the retrograde limb of the internal mammary vein has been described previously as a lifeboat for venous congestion but not prophylactically. Maximizing the length of the deep inferior artery perforator (DIEP) flap pedicle, identifying and dissecting the superficial inferior epigastric vein proximally in every patient, and taking advantage of the retrograde internal mammary vein are all technical details that facilitate the additional venous anastomosis and flap inset. Performing a second venous anastomosis routinely using the superficial inferior epigastric vein to the retrograde internal mammary vein helps with flap inset.
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Affiliation(s)
- Aparna Vijayasekaran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Anita T Mohan
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Lin Zhu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Basel Sharaf
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Michel Saint-Cyr
- Division of Plastic Surgery, Baylor Scott & White Health, Scott & White Memorial Hospital, MS-01-E443, 2401 South 31st Street, Temple, TX 76508, USA
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Computed Tomographic Angiography–Based Planning of Bipedicled DIEP Flaps with Intraflap Crossover Anastomosis. Plast Reconstr Surg 2016; 138:409e-418e. [DOI: 10.1097/prs.0000000000002432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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O'Neill AC, Hayward V, Zhong T, Hofer SO. Usability of the internal mammary recipient vessels in microvascular breast reconstruction. J Plast Reconstr Aesthet Surg 2016; 69:907-11. [DOI: 10.1016/j.bjps.2016.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/05/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
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12
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Dual-Pedicle Flap for Unilateral Autologous Breast Reconstruction Revisited. Plast Reconstr Surg 2016; 137:1372-1380. [DOI: 10.1097/prs.0000000000002075] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Discussion: Dual-Pedicle Flap for Unilateral Autologous Breast Reconstruction Revisited: Evolution and Optimization of Flap Design over 15 Years. Plast Reconstr Surg 2016; 137:1381-1382. [PMID: 27119912 DOI: 10.1097/prs.0000000000002077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Using the Retrograde Internal Mammary System for Stacked Perforator Flap Breast Reconstruction. Plast Reconstr Surg 2016; 137:265e-277e. [DOI: 10.1097/01.prs.0000475743.08559.b6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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A Comparative Study Between Deep Inferior Epigastric Artery Perforator and Thoracoacromial Venous Supercharged Deep Inferior Epigastric Artery Perforator Flaps. Ann Plast Surg 2016. [DOI: 10.1097/sap.0000000000000581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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The Retrograde Limb of Internal Mammary Vessels as Reliable Recipient Vessels in DIEP Flap Breast Reconstruction. Ann Plast Surg 2015; 74:447-53. [DOI: 10.1097/sap.0b013e31829fd2e3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Hassan S, Rasheed T, Raurell A. Salvage of a TRAM breast reconstruction flap using the retrograde internal mammary artery system. Indian J Plast Surg 2015; 47:447-9. [PMID: 25593439 PMCID: PMC4292131 DOI: 10.4103/0970-0358.146657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Free tissue transfer provides an optimal means for breast reconstruction in creating an aesthetically natural appearance that is durable over time. The choice of donor vessels vary from surgeon to surgeon, but the internal mammary axis is one of the most popular choices together with the thoracodorsal vessels. Aims and Results: We present the case of a salvaged free transverse rectus abdominis myocutaneous breast reconstruction in which end-to-end antegrade anastomosis to the internal mammary artery (IMA) was not possible due to frail vessel walls, but retrograde anastomosis to the IMA and antegrade anastomosis of internal mammary vessel resulted in a perfused and viable flap. Conclusion: We suggest the use of the retrograde internal mammary arterial system for microsurgical anastomosis when the anterograde flow is not adequate, the vessel wall is friable, and when other more common options are not available.
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Affiliation(s)
- Sameena Hassan
- Department of Plastic and Reconstructive Surgery, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Tuabin Rasheed
- Department of Plastic and Reconstructive Surgery, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Anna Raurell
- Department of Plastic and Reconstructive Surgery, Nottingham University Hospitals NHS Trust, United Kingdom
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A decision-making algorithm for recipient vein selection in bipedicle deep inferior epigastric artery perforator flap autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2014; 67:1089-93. [DOI: 10.1016/j.bjps.2014.04.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 02/13/2014] [Accepted: 04/29/2014] [Indexed: 11/23/2022]
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Cephalic Vein Transposition versus Vein Grafts for Venous Outflow in Free-flap Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e141. [PMID: 25289334 PMCID: PMC4174070 DOI: 10.1097/gox.0000000000000056] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/02/2014] [Indexed: 11/27/2022]
Abstract
Introduction: When recipient veins for free-flap breast reconstruction are unavailable or inadequate, vein grafts or cephalic vein transposition (CVT) an option to provide alternate venous outflow. There are no comparative data to elucidate the indications and outcomes for each. We hypothesize that the CVT is as reliable as vein grafts when indicated. Methods: All consecutive cases where a CVT or venous vein grafts were used for free-flap breast reconstruction between 2000 and 2012 were reviewed. Patient demographics, operative notes, indications, and flap survival were compared between the 2 groups. Results: Ten patients underwent a CVT and 38 patients received a vein graft for insufficient venous outflow. There were no differences in average age, body mass index, or comorbid conditions between the groups. Similarly, there was no difference in previous radiotherapy, timing of reconstruction, or side of reconstruction. A CVT was used for salvage following venous thrombosis in 7 patients (70.0%) and for primary venous outflow in the remaining patients due to inability to use the internal mammary vein. Vein grafts were performed primarily in 31 patients, 22 for augmenting venous drainage (supercharge), 9 for the dominant venous outflow, and 7 for salvage of a thrombosis. One patient in each group suffered a complete loss of the free flap (cephalic: 10.0% vs vein graft: 14.3%, P = 0.36). Conclusions: The CVT is a reliable alternate venous outflow that can be used as a primary recipient vein or as a salvage option following venous thrombosis. Surgeons should consider a CVT when primary recipient veins are compromised or unavailable.
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The Use of Retrograde Limb of Internal Mammary Vein in Autologous Breast Reconstruction With DIEAP Flap. Ann Plast Surg 2014; 72:281-4. [DOI: 10.1097/sap.0b013e3182605674] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Kubota Y, Mitsukawa N, Akita S, Hasegawa M, Satoh K. Postoperative patency of the retrograde internal mammary vein anastomosis in free flap transfer. J Plast Reconstr Aesthet Surg 2014; 67:205-11. [DOI: 10.1016/j.bjps.2013.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 09/02/2013] [Accepted: 10/07/2013] [Indexed: 11/25/2022]
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22
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Tan O, Yuce I, Aydin OE, Kantarci M. A radioanatomic study of the internal mammary artery and its perforators using multidetector computed tomography angiography. Microsurgery 2013; 34:277-82. [DOI: 10.1002/micr.22185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Onder Tan
- Faculty of Medicine; Department of Plastic Reconstructive and Aesthetic Surgery; Ataturk University; 25240 Erzurum Turkey
| | - Ihsan Yuce
- Faculty of Medicine; Department of Radiology; Ataturk University; 25240 Erzurum Turkey
| | - Osman Enver Aydin
- Faculty of Medicine; Department of Plastic Reconstructive and Aesthetic Surgery; Ataturk University; 25240 Erzurum Turkey
| | - Mecit Kantarci
- Faculty of Medicine; Department of Radiology; Ataturk University; 25240 Erzurum Turkey
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Salgarello M, Visconti G, Barone-Adesi L. A further strategy for managing intraoperative venous congestion in abdominally based autologous breast reconstruction. Plast Reconstr Surg 2013; 131:435e-436e. [PMID: 23446594 DOI: 10.1097/prs.0b013e31827c7110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marzia Salgarello
- Department of Plastic and Reconstructive Surgery (Salgarello, Visconti) Breast Unit, Catholic University of Sacro Cuore, University Hospital A. Gemelli, Rome, Italy (Barone-Adesi)
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