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Pividori M, Gangloff D, Ferron G, Meresse T, Delay E, Rivoire M, Perez S, Vaucher R, Frobert P. Outcomes of DIEP flap reconstruction after pelvic cancer surgery: A retrospective multicenter case series. J Plast Reconstr Aesthet Surg 2023; 85:242-251. [PMID: 37531805 DOI: 10.1016/j.bjps.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Flap reconstruction is often required after pelvic tumor resection to reduce wound complications. The use of perforator flaps has been shown to reduce donor site morbidity. The purpose of this study was to evaluate the outcomes of pedicled deep inferior epigastric perforator (pDIEP) flap reconstruction. METHODS This was a retrospective multicenter study of patients who underwent immediate pDIEP flap reconstruction for a pelvic or perineal defect after tumor resection between November 2012 and June 2022. The primary outcome was abdominal donor site morbidity, and the secondary outcome was perineal morbidity. RESULTS Thirty-four patients (median age, 57.5 years) who underwent pelvic exenteration (n = 31), extralevator abdominoperineal excision (n = 2), or extended vaginal hysterectomy (n = 1) were included. The most common indications were recurrent cervical (n = 19) and anal (n = 4) squamous cell carcinoma. Twenty-nine patients (85%) had a history of radiotherapy. Only one patient (3%) had major (Clavien-Dindo ≥ III) donor site complications (surgical site infection due to tumor recurrence). Eleven patients (32%) had at least one major recipient site complication (surgical site infection [n = 1], total [n = 2] or partial [n = 1] flap loss, perineal dehiscence [n = 2], hematoma [n = 1], fistula [n = 5]). No incisional or perineal hernias were observed during follow-up. Ninety-day survival was 100%. CONCLUSION Pedicled DIEP flap reconstructions performed by experienced surgical teams had good outcomes for perineal or vaginal reconstruction, with low abdominal morbidity, in patients with advanced pelvic malignancies who had undergone median laparotomy. The risks and benefits of this procedure should be carefully evaluated preoperatively using clinical and imaging data.
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Affiliation(s)
- Marc Pividori
- Department of Reconstructive and Plastic Surgery, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon, France; Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France.
| | - Dimitri Gangloff
- Department of Plastic Surgery, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Gwenaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Thomas Meresse
- Department of Plastic Surgery, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Emmanuel Delay
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Simon Perez
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Richard Vaucher
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Paul Frobert
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
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Varnava C, Wiebringhaus P, Kampshoff D, Hirsch T, Kueckelhaus M. Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap. Front Surg 2023; 10:1050172. [PMID: 37284559 PMCID: PMC10239860 DOI: 10.3389/fsurg.2023.1050172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/21/2023] [Indexed: 06/08/2023] Open
Abstract
Background Autologous breast reconstruction is highly regarded in reconstructive surgery after mastectomy. DIEP flap reconstruction represents the gold standard for autologous breast reconstruction. The major advantages of DIEP flap reconstruction are its adequate volume, large vascular caliber and pedicle length. Despite reliable anatomy, there are procedures where the plastic surgeon's creativity is required, not only to shape the new breast, but also to overcome microsurgical challenges. An important tool in these cases is the superficial epigastric vein (SIEV). Methods 150 DIEP flap procedures performed between 2018 and 2021 were retrospectively evaluated for SIEV use. Intraoperative and postoperative data were analyzed. Rate of anastomosis revision, total and partial flap loss, fat necrosis and donor site complications were evaluated. Results In a total of 150 breast reconstructions with a DIEP flap performed in our clinic, the SIEV was used in 5 cases. The indication for using the SIEV was to improve the venous drainage of the flap or as a graft to reconstruct the main artery perforator. Among the 5 cases, no flap loss occurred. Conclusions Use of the SIEV is an excellent method to expand the microsurgical options in breast reconstruction with DIEP flap surgery. It provides a safe and reliable procedure to improve venous outflow in cases of inadequate outflow from the deep venous system. The SIEV could also provide a very good option for fast and reliable application as an interposition device in case of arterial complications.
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Affiliation(s)
- Charalampos Varnava
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Philipp Wiebringhaus
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - David Kampshoff
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Tobias Hirsch
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
| | - Maximilian Kueckelhaus
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, Muenster, Germany
- Department of Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, University of Muenster, Muenster, Germany
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Kulkarni A, Dogra N, Zigras T. Innovations in the Management of Vaginal Cancer. Curr Oncol 2022; 29:3082-3092. [PMID: 35621640 PMCID: PMC9139564 DOI: 10.3390/curroncol29050250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/16/2022] Open
Abstract
Primary vaginal cancer is a rare gynecologic malignancy. Given the rarity of the disease, standardized approaches to management are limited, and a great variety of therapeutic conditions are endorsed. This paper reviews advances in surgical approaches, radiation, chemoradiation, and immunotherapy. Advances in surgical management including the increasing use of laparoscopic and endoscopic approaches, as well as the novel techniques in vaginal reconstruction, are reviewed. Concurrent chemoradiation remains a mainstay of treatment for vaginal cancer and has improved local control of disease and overall survival. Additionally, with metastatic disease or situations where toxicity from CCRT is unacceptable, systemic therapies including immunotherapy approaches are reviewed.
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Affiliation(s)
- Anjali Kulkarni
- Division of Gynecologic Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada;
| | - Nupur Dogra
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON M5G 1E2, Canada;
| | - Tiffany Zigras
- Trillium Health Partners, Division of Gynecologic Oncology, Mississauga, ON L5M 2N1, Canada
- Correspondence:
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Khoong YM, Huang X, Gu S, Zan T. Imaging for thinned perforator flap harvest: current status and future perspectives. BURNS & TRAUMA 2021; 9:tkab042. [PMID: 34926708 PMCID: PMC8677592 DOI: 10.1093/burnst/tkab042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/24/2021] [Indexed: 11/12/2022]
Abstract
With advances in anatomical knowledge and technology, increased interest has been directed towards reconstruction with enhanced aesthetic and functional outcomes. A myriad of thinned perforator flap harvest approaches have been developed for this purpose; however, concerns about jeopardizing their vascularity remain. To ensure optimum reconstructive outcome without hampering the flap's microcirculation, it is important to make good use of the existing advanced imaging modalities that can provide clear visualization of perforator branches, particularly in the adipose layer, and an accurate assessment of flap perfusion. Therefore, this review will highlight the imaging modalities that have been utilized for harvesting a thinned perforator flap from these two perspectives, along with future insights into creating both functionally and aesthetically satisfying, yet simultaneously safe, thinned perforator flaps for the best reconstructive outcomes for patients.
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Affiliation(s)
- Yi Min Khoong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shuchen Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Tao Zan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
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Ruffenach L, Boeri C, Ronde Oustau C, Bodin F, Bruant-Rodier C, Dissaux C. [A pedicled deep inferior epigastric flap to cover a hip arthroplasty infection]. ANN CHIR PLAST ESTH 2021; 67:101-104. [PMID: 34949489 DOI: 10.1016/j.anplas.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
The deep inferior epigastric perforator (DIEP) flap is a reliable flap mostly used in skin resurfacing after signifiant resection for sarcoma or correction contour deformities. This case is about a pedicled DIEP flap covering the trochanteric region after a total hip arthroplasty infection. A 62years old woman with a BMI at 42kg/m2 presents an infected total hip arthroplasty with a cutaneous defect. The hip prosthesis is changed and covered with a pedicled DIEP flap. This original case reports the used of pedicled DIEP flap in hip coverage. This local fasciocutaneous flap covered the hip osteoarticular infection. The limb is salved and the patient can walked again. The success of this surgery is the collaboration between infectious disease specialist, orthopedic surgeon and plastic surgeon.
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Affiliation(s)
- L Ruffenach
- Service de chirurgie plastique esthétique et reconstructrice, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France.
| | - C Boeri
- Service de chirurgie orthopédique septique, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - C Ronde Oustau
- Service de chirurgie orthopédique septique, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - F Bodin
- Service de chirurgie plastique esthétique et reconstructrice, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - C Bruant-Rodier
- Service de chirurgie plastique esthétique et reconstructrice, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
| | - C Dissaux
- Service de chirurgie plastique esthétique et reconstructrice, hôpital de Hautepierre, CHRU Strasbourg, 67000 Strasbourg, France
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Akita S, Nakaguchi T, Tokumoto H, Yamaji Y, Arai M, Yasuda S, Ogata H, Tezuka T, Kubota Y, Mitsukawa N. The usefulness of a free thinned deep inferior epigastric artery perforator flap and measurement of the vascular pedicle length: A thin flap with a long pedicle. J Plast Reconstr Aesthet Surg 2021; 75:1579-1585. [PMID: 34973933 DOI: 10.1016/j.bjps.2021.11.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/28/2021] [Accepted: 11/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The thinned deep inferior epigastric perforator (DIEP) flap branching from the main trunk to the superolateral direction may be useful because of its long vascular pedicle. DIEP flap is used as an axial-pattern adipose flap. The vascular pedicle length of the thinned DIEP flap was investigated using originally developed software. The clinical application of the thinned DIEP flap was verified in a case series. METHODS In 40 patients with enhanced computed tomography (CT) data, the vascular pedicle length of the longest thinned DIEP flap was simulated using the software. A free thinned DIEP flap was used in 10 clinical cases of facial or breast reconstruction. RESULTS In all simulated cases, the vascular pedicle of the DIEP branching to the superolateral direction was the longest, and the vascular pedicle could be lengthened up to 34.8% by dissecting the vessels on the fascia as a vascular pedicle. In all the clinical cases, the reconstruction of a complex form defect or reconstruction requiring a long vascular pedicle could be achieved in one stage without any perioperative complications. The intraclass correlation coefficient between simulated pedicle length and dissected pedicle length was 0.99. CONCLUSION Thinned DIEP flaps with long vascular pedicles could be elevated safely. Multiple adipose or muscle flaps could be combined without complications. The length of the winding vascular pedicle could be measured using imaging data using the software first developed in the present study. This software would be useful in the planning of a thinned DIEP flap and other free flaps.
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Affiliation(s)
- Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Toshiya Nakaguchi
- Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
| | - Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Chiba, Japan
| | - Yoshihisa Yamaji
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Minami Arai
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Saori Yasuda
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideyuki Ogata
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takafumi Tezuka
- Department of Dermatology and Plastic and Reconstructive Surgery, Akita University Graduate School of Medicine and Faculty of Medicine, Akita, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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7
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Elia J, Do NTK, Chang TNJ, Lai CH, Chou HH, Chang FCS, Huang JJ. Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps. J Reconstr Microsurg 2021; 38:10-26. [PMID: 33853124 DOI: 10.1055/s-0041-1727199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. METHODS A retrospective review was conducted of all patients who underwent vulvar-perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed. RESULTS Thirty-three patients underwent 55 soft tissue reconstructions for vulvar-perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications. CONCLUSION In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results.
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Affiliation(s)
- Jhonatan Elia
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Nicholas T K Do
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tommy N-J Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Hung-Hsueh Chou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Frank C-S Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Craniofacial Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Jung-Ju Huang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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8
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Song B, Zhang Z, Liu Q, Li Y, Zhang J, Pei J, Tuo Z. Thinned Pedicle Deep Inferior Epigastric Perforator (DIEP) Flap for Scrotal Reconstruction. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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9
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Miyamoto S, Arikawa M, Kagaya Y. The use of lower abdominal perforator flaps in soft‐tissue reconstruction after sarcoma resection. Microsurgery 2019; 40:353-360. [DOI: 10.1002/micr.30539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 09/13/2019] [Accepted: 11/08/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Shimpei Miyamoto
- Division of Plastic and Reconstructive Surgery National Cancer Center Hospital Tokyo Japan
| | - Masaki Arikawa
- Division of Plastic and Reconstructive Surgery National Cancer Center Hospital Tokyo Japan
| | - Yu Kagaya
- Division of Plastic and Reconstructive Surgery National Cancer Center Hospital Tokyo Japan
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10
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Jiang C, Yang Y, Zeng F, Wang X, Fang B. [Research progress in thin flap and flap thinning technique]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:912-916. [PMID: 31298013 PMCID: PMC8337439 DOI: 10.7507/1002-1892.201901090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/15/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To review the historical origin and development of thin flap and flap thinning technique. METHODS A wide range of domestic and foreign literatures on thin flaps and flap thinning technique were reviewed. The background, definition, methods, problems, challenges, and future development of thin flap and flap thinning technique were summarized and analysed. RESULTS Thin flap and flap thinning technique play an important role in the development of flap surgery, leading flap surgery towards a more rational and refined direction. CONCLUSION Thin flap and flap thinning technique are still hot topics in the future. With the development of thin flap and flap thinning technique, clinicians will have more "free" choices.
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Affiliation(s)
- Conghang Jiang
- Department of Burn and Plastic Surgery, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P.R.China
| | - Yuanming Yang
- Department of Burn and Plastic Surgery, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P.R.China
| | - Fanglin Zeng
- Department of Burn and Plastic Surgery, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P.R.China
| | - Xiancheng Wang
- Department of Burn and Plastic Surgery, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011,
| | - Bairong Fang
- Department of Burn and Plastic Surgery, the Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P.R.China
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Kadota H, Momii K, Hanada M, Kamizono K, Inatomi Y, Hisanaga K, Yoshida S, Ogaki K, Kiyoshima K. Simultaneous deep inferior epigastric and bilateral anterolateral thigh perforator flap reconstruction of an extended perineoscrotal defect in Fournier's gangrene: A case report. Microsurgery 2019; 39:263-266. [PMID: 30666712 DOI: 10.1002/micr.30409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/28/2018] [Accepted: 11/16/2018] [Indexed: 11/06/2022]
Abstract
Fournier's gangrene is lethal necrotizing fasciitis that involves the perineum and external genitalia. We describe the case of a 52-year-old man with Fournier's gangrene who underwent reconstruction of an extensive perineoscrotal defect using three pedicled perforator flaps. Three debridement procedures resulted in a skin and soft tissue defect of 36 × 18 cm involving the perineum, scrotum, groin, medial thigh, buttocks, and circumferential perianal area and left the perforating arteries originating from these locations unavailable for reconstruction. We repaired the defect using left deep inferior epigastric artery perforator (DIEP) (29 × 8 cm) and bilateral anterolateral thigh perforator (ALT) flaps (35 × 8 cm and 22 × 7 cm). The flaps reached the defect without tension, and the defect was successfully covered without a skin graft. No postoperative complications occurred except for epidermal necrosis involving a tiny part of the DIEP flap tip. Nine months postoperatively, the patient experienced no impairment of bowel function or hip joint movement. There was also no avulsion or ulceration of the reconstructed perineal skin, and the cosmetic appearances of the healed wound and donor site were satisfactory. The combination of these three perforator flaps enabled us to achieve a satisfactory outcome while avoiding skin grafts.
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Affiliation(s)
- Hideki Kadota
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Kenta Momii
- Department of Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Masuo Hanada
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichi Kamizono
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Yusuke Inatomi
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Kana Hisanaga
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Sei Yoshida
- Department of Plastic and Reconstructive Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Kippei Ogaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keijiro Kiyoshima
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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12
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Perineal Closure after Abdominoperineal Resection Using a Pedicled Deep Inferior Epigastric Perforator Flap: A Safe Alternative to Rectus Abdominis Myocutaneous Flap. J Am Coll Surg 2018; 227:e1-e4. [DOI: 10.1016/j.jamcollsurg.2018.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 12/28/2022]
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13
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Dast S, Vaucher R, Rotari V, Assaf N, David E, Christian H, Sinna R. Les lambeaux cutanés minces dans la prise en charge des pertes de substance cutanée de la main et du membre supérieur. ANN CHIR PLAST ESTH 2017; 62:69-78. [DOI: 10.1016/j.anplas.2016.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
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14
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Monsivais SE, Webster ND, Wong S, Saint-Cyr MH. Pre-expanded Deep Inferior Epigastric Perforator Flap. Clin Plast Surg 2017; 44:109-115. [DOI: 10.1016/j.cps.2016.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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The Concepts of Propeller, Perforator, Keystone, and Other Local Flaps and Their Role in the Evolution of Reconstruction. Plast Reconstr Surg 2016; 138:710e-729e. [DOI: 10.1097/prs.0000000000002610] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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16
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Perineal Flap Reconstruction after Oncologic Resection. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e657. [PMID: 27257587 PMCID: PMC4874301 DOI: 10.1097/gox.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Kosutic D, Bullen T, Fulford P. Profunda artery perforator flap for perineal reconstruction: A new indication. Microsurgery 2015; 36:615-616. [DOI: 10.1002/micr.30002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/20/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Damir Kosutic
- Department of Plastic and Reconstructive Surgery; Christie NHS Foundation Trust; Manchester UK
| | - Timothy Bullen
- Department of Surgery; Christie NHS Foundation Trust; Manchester UK
| | - Paul Fulford
- Department of Surgery; Christie NHS Foundation Trust; Manchester UK
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18
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Ferron G, Gangloff D, Querleu D, Frigenza M, Torrent JJ, Picaud L, Gladieff L, Delannes M, Mery E, Boulet B, Balague G, Martinez A. Vaginal reconstruction with pedicled vertical deep inferior epigastric perforator flap (diep) after pelvic exenteration. A consecutive case series. Gynecol Oncol 2015; 138:603-8. [PMID: 26121919 DOI: 10.1016/j.ygyno.2015.06.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 01/11/2023]
Abstract
Vaginal reconstruction after pelvic exenteration (PE) represents a challenge for the oncologic surgeon. Since the introduction of perforator flaps, using pedicled vertical DIEP (deep inferior epigastric perforator) flap allows to reduce the donor site complication rate. From November 2012 to December 2014, 27 PEs were performed in our institution. 13 patients who underwent PE with vaginal reconstruction and programmed DIEP procedure for gynecologic malignancies were registered. Nine patients underwent PE for recurrent disease and four for primary treatment. Six of the 13 patients have a preoperative fistula. Anterior PE was performed in 10 patients, and total PE in 3 patients. A vertical DIEP flap was performed in 10 patients using one or two medial perforators. The reasons for abortion of vertical DIEP flap procedure were: failure to localizing perforator vessels in two cases, and unavailability of plastic surgeon in one case. A vertical fascia-sparring rectus abdominis myocutaneous flap was then harvested. Median length of surgery was 335min, and 60min for DIEP harvesting and vaginal reconstruction. No flap necrosis occurred. One patient in the VRAM (vertical rectus abdominis myocutaneous) group experienced a late incisional hernia and one patient in the DIEP flap group required revision for vaginal stenosis. In our experience, DIEP flap represents our preferred choice of flap for circumferential vaginal reconstruction after PE. To achieve a high reproducibility, the technically demanding pedicled vertical DIEP flap has to be harvested by a trained surgeon, after strict evaluation of the preoperative imaging with identification and localization of perforator vessels.
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Affiliation(s)
- Gwénael Ferron
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France.
| | - Dimitri Gangloff
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Denis Querleu
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France; Department of Surgical Oncology, Institut Bergonie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Melanie Frigenza
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Juan Jose Torrent
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France; Departement of Gynecology, Hospital Universitari Germans Trias y Pujol, Carretera de Canyet, 08916 Badalona, Barcelona, Spain
| | - Laetitia Picaud
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Laurence Gladieff
- Departement of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Martine Delannes
- Departement of Radiation Therapy, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Eliane Mery
- Department of Surgical Pathology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Berenice Boulet
- Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Gisele Balague
- Department of Radiology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer, 1 av Joliot Curie, 31000 Toulouse Cedex 09, France
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Bodin F, Robert E, Dissaux C, Weitbruch D, Bruant-Rodier C, Rodier JF. Extended vulvar immediate reconstruction using the bilateral transverse pedicled DIEP flap. J Plast Reconstr Aesthet Surg 2015; 68:745-7. [DOI: 10.1016/j.bjps.2015.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/12/2014] [Accepted: 01/11/2015] [Indexed: 11/27/2022]
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20
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Niranjan NS, Fox P, Mittermiller P, Lee GK, Evans K, Mushtaq I. Genitourinary and perineal reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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21
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Vascular anatomy of the deep inferior epigastric artery perforator flap: a systematic review. Plast Reconstr Surg 2015; 134:810e-821e. [PMID: 25347657 DOI: 10.1097/prs.0000000000000625] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The deep inferior epigastric artery perforator (DIEP) flap is one of the most commonly used perforator flaps for reconstruction. The anatomy of the flap varies considerably between patients and even within patients. The authors conducted a comprehensive review to fully describe the vascular anatomy of the DIEP flap. METHODS The authors performed MEDLINE, Ovid, and PubMed searches for articles published between 1993 and 2012 on the vascular anatomy of the DIEP flap. Abstracts were screened first, then entire articles, followed by manual reference check. A total of 60 relevant articles were identified and reviewed in their entirety. The authors synthesized all descriptions of DIEP flap vascular anatomy. RESULTS The perforators originating from the deep inferior epigastric artery can be categorized as musculocutaneous or extramuscular. Musculocutaneous perforators are the most common (33 to 100 percent), followed by extramuscular (0 to 67.6 percent). Of the musculocutaneous perforators, a short intramuscular course (<4 cm) is most common (61 to 80 percent), followed by a long intramuscular course (>4 cm; 9 to 26 percent) and a perpendicular course (3 to 26 percent). Two subfascial patterns have been described, with direct fascial penetration more common than a subfascial course. The two extramuscular perforator types, paramedian (<46.4 percent) and tendinous (<67.6 percent), are the most desirable for dissection. CONCLUSIONS The vascular anatomy of the DIEP flap shows significant variability. Despite this, several patterns of musculocutaneous and extramuscular-type perforators have been found. A greater understanding of these patterns will improve knowledge of the anatomical variation and will enhance the use of evidence-based perforator selection.
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Zheng L, Dong ZG, Zheng J. Deep inferior epigastric vessel-pedicled, muscle-sparing rectus abdominis myocutaneous (RAM) flap for reconstruction of soft tissue defects in pelvic area. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:859-63. [PMID: 25633126 DOI: 10.1007/s00590-015-1599-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/31/2014] [Indexed: 12/01/2022]
Abstract
Large soft tissue reconstruction in pelvic area is rare but remains challenging. Between August of 2000 and March of 2014, five patients underwent soft tissue reconstruction in pelvic area using deep inferior epigastric vessel-pedicled, muscle-sparing RAM flap. The soft tissue defects located in anterior iliac spine in three cases, lower buttock in one case, contralateral lower buttock and perineal region in one case. The size of the flaps ranged from 13 × 7 cm to 25 × 9 cm. All flaps were harvested in muscle-sparing form. Lateral two-thirds of rectus abdominis muscle and anterior sheath of the rectus abdominis muscle were harvested with the flap in disc or bar shape. All five flaps survived uneventfully. During the follow-up, no ventral hernias occurred in donor sites.
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Affiliation(s)
- L Zheng
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, People's Republic of China,
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24
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Reconstruction d’une perte de substance de racine de cuisse sur membre lymphœdèmateux par un lambeau DIEP pédiculé. ANN CHIR PLAST ESTH 2014; 59:212-4. [PMID: 23379977 DOI: 10.1016/j.anplas.2013.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/03/2013] [Indexed: 11/23/2022]
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25
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Comparison of TRAM versus DIEP Flap in Total Vaginal Reconstruction after Pelvic Exenteration. Plast Reconstr Surg 2013; 132:1020e-1027e. [DOI: 10.1097/prs.0b013e3182a97ea2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Abstract
Extramammary Paget's disease is uncommon. Diagnosis has to be confirmed by histopathology. Treatment is a challenge in cases with extended tumors. We present a 70-year-old male patient with extensive genitoanal Paget's disease. Mohs surgery is the gold standard in such cases. Details of the surgical planning are discussed including wound bed preparation. Radiotherapy may be an alternative.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital, Friedrichstadt, Dresden, Germany
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