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Le TP, Le AT, Huynh TND, Huynh KQ, Dao TH, Desgranges P, Bosc R. Duplex Imaging Assessment of the Internal Mammary Arteries in Women after Unilateral Mastectomy and Radiotherapy for Breast Cancer. Ann Vasc Surg 2024; 100:15-24. [PMID: 38110082 DOI: 10.1016/j.avsg.2023.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The effects of incidental radiation exposure on internal mammary arteries remain unclear. The present study was designed to test the hypothesis by comparing diameter and blood flow of the irradiated and nonirradiated internal mammary arteries, using Duplex ultrasound imaging. METHODS The study was designed as a single-center, transversal, comparative study. The main outcomes were diameter and volumetric blood flow of the internal mammary arteries. The Wilcoxon rank-sum test was used to assess the differences between the irradiated and nonirradiated internal mammary arteries with regard to the diameter and volumetric blood flow. RESULTS The diameter (median [interquartile range]) of the irradiated internal mammary arteries (0.170 mm [0.160, 0.180]) was smaller than that of the contralateral nonirradiated ones (0.180 mm [0.170, 0.200], P < 0.0001) and that of the internal mammary arteries in the control group (0.180 mm [0.170, 0.190], P < 0.0001). Similarly, blood flow (median [interquartile range]) of the irradiated internal mammary arteries (52.4 ml/min [37.78, 65.57]) was smaller than that of the contralateral nonirradiated ones (62.7 ml/min [46.87, 84.17], P < 0.0001), as well as of the left (56.7 ml/min [46.88, 72.58], P = 0.02) and the right internal mammary arteries in the control group (61.0 ml/min [47.47, 74.52], P = 0 0.0009). CONCLUSIONS The data indicate that the irradiated internal mammary arteries in patients with a history of total mastectomy followed by radiotherapy for breast cancer had significantly smaller diameter and blood flow compared to the nonirradiated internal mammary arteries.
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Affiliation(s)
- Thanh-Phong Le
- Department of Vascular Surgery, Cho Ray Hospital, Ho Chi Minh City, Vietnam; L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France.
| | - Anh T Le
- Oncology Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tan N D Huynh
- Department of Diagnostic Ultrasonography, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Khanh Q Huynh
- Oncology Center, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thu-Ha Dao
- Department of Imaging, Henri Mondor Hospital, Creteil, France
| | - Pascal Desgranges
- L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France; Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France
| | - Romain Bosc
- L'École Doctorale Sciences de la Vie et de la Santé (Doctoral School of Life and Health Sciences), University of Paris-Est, Creteil, France; Department of Plastic, Esthetic and Reconstructive Surgery, George- Pompidou Hospital, Paris, France
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2
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Pruimboom T, Tuinder SMH, Qiu SS, Keuter XHA, van der Hulst RRWJ. The impact of using the internal mammary artery as a recipient vessel on medial mastectomy skin flap perfusion in autologous breast reconstruction: An observational study using indocyanine green. J Plast Reconstr Aesthet Surg 2023; 84:350-356. [PMID: 37390544 DOI: 10.1016/j.bjps.2023.06.016] [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: 09/12/2022] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND The internal mammary artery (IMA) is the preferred recipient vessel for microvascular anastomosis in immediate autologous breast reconstruction following skin-sparing mastectomy (SSM). Although the IMA accounts for approximately 60% of the blood supply to the breast, the exact contribution to the mastectomy skin flap perfusion is unclear. The aim of this observational study was to investigate the impact of using the IMA as a recipient vessel on medial mastectomy skin flap perfusion assessed with indocyanine green angiography (ICGA). METHODS This observational study included ten consecutive women who underwent immediate autologous breast reconstructions following SSM. Two intraoperative indocyanine green (ICG) assessments were performed to assess tissue perfusion of the upper and lower part of the medial mastectomy skin flap: the first following the SSM and the second after clamping the IMA. During a 120-second angiography, three additional images were made after 60, 90, and 120 s. The ICG inflow time and mean, minimum, and maximum fluorescence intensities (FIs) were obtained. RESULTS Four unilateral and six bilateral autologous breast reconstructions were included. There was no difference in tissue perfusion when comparing the inflow time (24.1 s vs. 23.0 s, P = 0.348), the mean FI (131.4 vs. 124.0, P = 0.126), minimum FI (28.6 vs. 33.4, P = 0.086), and maximum FI (253.1 vs. 247.6, P = 0.166) before and after clamping the IMA. CONCLUSION According to this study, the use of the IMA as a recipient vessel does not reduce medial mastectomy skin flap perfusion in patients undergoing immediate autologous breast reconstructions following SSM.
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Affiliation(s)
- T Pruimboom
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University & Maastricht University Medical Center, Maastricht, the Netherlands.
| | - S M H Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University & Maastricht University Medical Center, Maastricht, the Netherlands
| | - S S Qiu
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University & Maastricht University Medical Center, Maastricht, the Netherlands
| | - X H A Keuter
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University & Maastricht University Medical Center, Maastricht, the Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University & Maastricht University Medical Center, Maastricht, the Netherlands
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Zhu A, Perrotta A, Choi V, Haykal S, Zhong T, Hofer SOP, O'Neill AC. Intraoperative vasopressor use does not increase complications in microvascular post-mastectomy breast reconstruction: Experience in 1729 DIEP flaps at a single center. J Plast Reconstr Aesthet Surg 2023; 84:1-8. [PMID: 37315455 DOI: 10.1016/j.bjps.2023.03.010] [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: 11/09/2022] [Revised: 02/24/2023] [Accepted: 03/15/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION Vasopressors are traditionally avoided in microsurgery due to concerns about their effect on free flap survival. We examine the impact of intraoperative vasopressors on microsurgical outcomes in a large series of DIEP flap breast reconstructions. METHODS A retrospective chart review was performed of patients who underwent DIEP breast reconstruction between January 2010 and May 2020. Intraoperative and postoperative microsurgical outcomes were compared in patients who received vasopressors and those who did not. RESULTS The study included 1102 women who underwent 1729 DIEP. 878 patients (79.7%) received intraoperative phenylephrine, ephedrine, or a combination of both. There was no significant difference in overall complications, intraoperative microvascular events, takebacks for microvascular complications, or partial or total flap loss between groups. Outcomes were not affected by vasopressor type, dose, or timing of administration. The vasopressor group received significantly lower intraoperative fluid volumes. Multivariate logistic regression found a significant association between overall complications and excessive fluids (OR 2.03, 99% CI 0.98-5.18, p = 0.03) but not vasopressor use (OR 0.79, 99% CI 0.64-3.16, p = 0.7) CONCLUSION: This study demonstrates that vasopressors do not adversely affect clinical outcomes after DIEP breast reconstruction. Withholding vasopressors results in excessive intravenous fluid administration and increased postoperative complications.
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Affiliation(s)
- Alice Zhu
- Division of Plastic and Reconstructive Surgery and Division of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Canada
| | - Amanda Perrotta
- Division of Plastic and Reconstructive Surgery and Division of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Canada
| | - Vincent Choi
- Division of Plastic and Reconstructive Surgery and Division of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Canada
| | - Siba Haykal
- Division of Plastic and Reconstructive Surgery and Division of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery and Division of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Canada
| | - Stefan O P Hofer
- Division of Plastic and Reconstructive Surgery and Division of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Canada
| | - Anne C O'Neill
- Division of Plastic and Reconstructive Surgery and Division of Surgical Oncology, University Health Network, Department of Surgery, University of Toronto, Canada.
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Breast Reconstruction Trends in the Setting of Postmastectomy Radiation Therapy: Analysis of Practices among Plastic Surgeons in the United States. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4800. [PMID: 36817273 PMCID: PMC9937102 DOI: 10.1097/gox.0000000000004800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 12/07/2022] [Indexed: 02/19/2023]
Abstract
Radiation is an integral part of breast cancer therapy. The ideal type and timing of breast reconstruction with relation to radiation delivery are not well established. The study aimed to identify reconstructive practices among American plastic surgeons in the setting of pre- and postmastectomy radiation. Methods A cross-sectional survey of members of the American Society of Plastic Surgery was performed. Practice/demographic information and breast reconstruction protocols were queried. Univariate descriptive statistics were calculated, and outcomes were compared across cohorts with χ2 and Fischer exact tests. Results Overall, 477 plastic surgeons averaging 16.3 years in practice were surveyed. With respect to types of reconstruction, all options were well represented, although nearly 60% preferred autologous reconstruction with prior radiation and 55% preferred tissue expansion followed by implant/autologous reconstruction in the setting of unknown postoperative radiation. There was little consensus on the optimal timing of reconstruction in the setting of possible postoperative radiation. Most respondents wait 4-6 or 7-12 months between the end of radiation and stage 2 implant-based or autologous reconstruction. Common concerns regarding the effect of radiation on reconstructive outcomes included mastectomy flap necrosis, wound dehiscence, capsular contracture, tissue fibrosis, and donor vessel complications. Conclusions Despite considerable research, there is little consensus on the ideal type and timing of reconstruction in the setting of pre- and postoperative radiation. Understanding how the current body of knowledge is translated into clinical practice by different populations of surgeons allows us to forge a path forward toward more robust, evidence-based guidelines for patient care.
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Tokumoto H, Akita S, Kosaka K, Kubota Y, Mitsukawa N. Utilization of a partial rib-sparing procedure in microvascular breast reconstruction for preserving intercostal nerve and nipple reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:4354-4360. [PMID: 36253301 DOI: 10.1016/j.bjps.2022.08.041] [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: 10/12/2021] [Revised: 05/19/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In microvascular breast reconstruction, internal mammary vessel (IMV) exposure has been performed. The preservation of intercostal nerve (ICN) is effective for preserving sensibility and decreasing postoperative pain. In nipple reconstruction, cartilage grafting is performed to provide additional support and projection. We considered that ICN preservation and costal cartilage banking could be performed simultaneously. This method was described as the "partial rib-sparing procedure." The purpose of this study was to introduce this procedure. METHODS Surgical technique of this procedure was as follows. The second intercostal space was used. The width of the trimmed cartilage was kept within the superior half of the third costal cartilage. Soft tissue within 5 mm of the inferior border of the second rib edge was preserved to save the second ICN. The length of IMVs in the partial rib-sparing procedure and that in the total rib-sparing procedure was compared. RESULTS The number of patients in the partial rib-sparing and total rib-sparing groups was 137 procedures and 57 procedures, respectively. The length of IMVs was significantly longer in the partial rib-sparing procedure (median 20.5 mm vs. 17.6 mm, P < 0.001). In the partial rib-sparing group, no patient complained of prolonged local pain, and chest wall contour abnormalities were absent in all cases. CONCLUSIONS The partial rib-sparing procedure is superior, especially for patients with narrow intercostal spaces and/or patients who decide to undergo nipple reconstruction with costal cartilage. This procedure could be performed to preserve the soft tissues around the ICN and decrease the postoperative pain.
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Affiliation(s)
- Hideki Tokumoto
- Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Japan.
| | - Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 66-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan
| | - Kentaro Kosaka
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 66-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan
| | - Yoshitaka Kubota
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 66-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, 66-2 Nitona, Chuo-ku, Chiba City, Chiba 260-8717, Japan
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6
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Buffoli B, Verzeletti V, Gabusi V, Giugno L, Hirtler L, Faini G. Anatomical basis of retrograde thoracic veins flow and its implications in complex thoracic wall reconstructive surgery. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1319-1328. [PMID: 36129523 PMCID: PMC9649502 DOI: 10.1007/s00276-022-03015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/29/2022] [Indexed: 12/03/2022]
Abstract
Purpose Internal thoracic veins are increasingly used as recipient’s vessels in chest wall reconstructive surgery due to their predictable anatomy and to the possibility to make a double venous anastomosis, exploiting the retrograde flow within them. Over the years, retrograde flow had been explained by the absence of valves in internal thoracic veins, which have been found recently instead. Therefore, our aim is to analyze the retrograde flow and its relationship with valves in the internal thoracic veins. Methods We evaluated 32 internal thoracic veins of 16 fresh-frozen specimens with undamaged thoracic cages by dynamic analysis focused on retrograde flow assessment through a partial external circulation system obtained cannulating the subclavian veins. Gross anatomical and morphological evaluations about the presence of valves and their pattern were then made. Results Efficient, partial, and absent retrograde flow was, respectively, found in 17/30, 8/30 and ITVs and 5/30 internal thoracic veins. Following Arnez’s classification, 20/32 Type I and 12/32 Type II internal thoracic veins were identified. Valves were observed in 10/16 specimens (62.50%) corresponding to 36.67% of examined veins (11/30). Three valves were found between the 2nd intercostal space and 12 valves in the 3rd intercostal space. 13/15 valves were bicuspid, 2/15 tricuspid. A significant correlation (p < 0.001) between the retrograde flow and the presence of valves in internal thoracic veins was observed. Conclusion Our study suggests a possible influence of the presence and the number of valves in the efficient retrograde flow of the internal thoracic veins, suggesting that, especially for more complex cases, a preoperative or intraoperative evaluation of the chest wall drainage should be recommended.
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Affiliation(s)
- Barbara Buffoli
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy.
- Interdipartimental University Center of Research "Adaptation and Regeneration of Tissues and Organs (ARTO)", University of Brescia, 25123, Brescia, Italy.
| | - Vincenzo Verzeletti
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Vittoria Gabusi
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy
| | - Lorena Giugno
- Anatomy and Physiopathology Division, Department of Clinical and Experimental Sciences, University of Brescia, V.le Europa 11, 25123, Brescia, Italy
| | - Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Gianpaolo Faini
- Unit of Plastic and Reconstructive Surgery, "Ospedale di Esine", Esine, Italy
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Nixon Martins A, Nunes Pombo J, Paias Gouveia C, Gomes Rosa B, Ribeiro G, Pinheiro C. Contralateral internal mammary vessels – a rescue recipient vessels option in breast reconstruction. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2022; 9:84-87. [PMID: 35295792 PMCID: PMC8920397 DOI: 10.1080/23320885.2022.2048179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Artur Nixon Martins
- Plastic, Reconstructive and Aesthetic Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - João Nunes Pombo
- Plastic, Reconstructive and Aesthetic Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Catarina Paias Gouveia
- Plastic, Reconstructive and Aesthetic Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Bruno Gomes Rosa
- Plastic, Reconstructive and Aesthetic Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Gaizka Ribeiro
- Plastic, Reconstructive and Aesthetic Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Carlos Pinheiro
- Plastic, Reconstructive and Aesthetic Surgery, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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Hand-sewn, coupler and Doppler-assisted venous anastomosis in free flap surgery: a systematic review and meta-analysis. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01854-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ismagilov A, Vanesyan A, Ovchinnikova I, Khamitov A, Basiashvili G, Zinchenko S. New technique of dissection of internal mammary vessels for breast reconstruction. Gland Surg 2020; 9:886-892. [PMID: 32953597 DOI: 10.21037/gs-20-104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although internal mammary vessels are considered the best recipients for free flap breast reconstruction, they present the notable drawback of limited accessibility. The aim of this study was to develop a minimally invasive surgical technique for the dissection of internal mammary vessels as recipients for breast reconstruction. Methods From 2008 to 2018, we performed 32 unilateral microsurgical breast reconstructions (mean patient age: 40.1±8.7 years; range, 23-58 years). As internal mammary vessels were exclusively used as recipients, they were dissected using a technique of minimally invasive video-assisted thoracoscopic surgery (VATS) developed in our hospital. Results The mean surgery time was 5.4±0.55 hours (range, 4.5-6.5 hours), and the mean duration of VATS dissection of internal mammary vessels was 20.6±2.9 minutes (range, 16-27 minutes). Of the specific complications associated with VATS, we only observed reductions in forced expiratory volume in the first second of >15% in 3 patients (9.4%), 10-15% in 8 patients (25%), and <10% in 21 patients (65.63%). We did not have any cases of significant bleeding or postoperative infection in this series of patients. With regard to aesthetic complications, we observed 1 and 2 cases of total necrosis and partial necrosis of the deep inferior epigastric perforator (DIEP) flap, respectively and 2 cases of partial necrosis of supercharged transverse rectus abdominis muscle flap. Conclusions Endoscopic dissection of internal mammary vessels is a simple and feasible technique. When performed by experienced surgeons, it is a fast procedure that is associated with low rate of complications.
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Affiliation(s)
- Arthur Ismagilov
- Department of Surgery, Kazan Federal University, Kazan, Russia.,Department of Plastic Surgery, Kazan State Medical Academy, Kazan, Russia.,Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - Anna Vanesyan
- Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - Irina Ovchinnikova
- Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - Airat Khamitov
- Department of Plastic Surgery, Kazan State Medical Academy, Kazan, Russia.,Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - George Basiashvili
- Department of Plastic Surgery, Kazan State Medical Academy, Kazan, Russia.,Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
| | - Sergei Zinchenko
- Department of Surgery, Kazan Federal University, Kazan, Russia.,Department of Plastic Surgery, Kazan State Medical Academy, Kazan, Russia.,Department of Breast Surgery, Regional Clinical Oncological Center of Tatarstan, Kazan, Russia
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Diametric Comparison between the Thoracodorsal Vessel and Deep Inferior Epigastric Vessel in Breast Reconstruction. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6352939. [PMID: 32724804 PMCID: PMC7381952 DOI: 10.1155/2020/6352939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/25/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Background In microvascular anastomosis, size discrepancy is common and can increase thrombotic complications. If size differences can be predicted, then vessels of the appropriate size can be selected. This study documented the difference in diameter between the thoracodorsal (TD) vessel and deep inferior epigastric perforator (DIEP) pedicle in each patient who underwent breast reconstruction using free tissue transfer. Patients and Methods. This retrospective study included 32 anastomoses (27 breasts including five cases of supercharged anastomosis) of breast reconstruction with the free DIEP flap and TD recipient between August 2018 and June 2019. In the microscopic view, the caliber of the TD vessel, the largest branch to the serratus anterior muscle, the descending branch, the largest and the second largest branches to the latissimus dorsi muscle, and the DIEP pedicle were measured. Results The diameter of the deep inferior epigastric artery was similar to that of the descending branch, and their anastomosing rate was 56.3%. The diameter of the deep inferior epigastric vein was similar to the branch to the serratus anterior muscle and the descending branch, and their anastomosing rates were 29.3% and 29.3%, respectively. All flaps were survived; however, in one case, a reoperation was needed to remove the hematoma, in which case fat necrosis occurred as the only complication. Conclusion TD branches of similar size to the DIEP pedicle were prioritized in anastomosis. The descending branch and the branch to the serratus anterior muscle are expected to be good candidates as recipients in breast reconstruction with DIEP free flap. Moreover, supercharged anastomosis of DIEP pedicles can be achieved within TD branches.
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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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12
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Muto M, Satake T, Masuda Y, Kobayashi S, Tamura S, Kobayashi S, Ohtake T, Maegawa J. Absent Internal Mammary Recipient Vein in Autologous Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2660. [PMID: 32309101 PMCID: PMC7159964 DOI: 10.1097/gox.0000000000002660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
The internal mammary vessels (IMA/Vs) have been used as the first-choice recipient vessels for microsurgical anastomosis and flap inset in autologous breast reconstruction owing to their ease of access and use compared with the thoracodorsal vessels (TDA/Vs). Herein, we report two cases of deep inferior epigastric perforator flap breast reconstructions in which the recipient internal mammary vein (IMV) was lacking. In the first case, a 50-year-old patient underwent delayed two-stage reconstruction, and in the second, a 45-year-old patient underwent delayed reconstruction because of capsular contracture following breast implant reconstruction. Neither patient received preoperative radiation therapy. During IMA/V preparation, we could not find the internal mammary vein (IMV) around the internal mammary artery (IMA) despite careful dissection. No internal mammary lymph node adenopathy and vascular encasement from metastasis were noted. Intraoperative indocyanine green angiography revealed absence of IMV, which was presumed to be congenital. Therefore, microsurgical anastomosis was performed to connect the deep inferior epigastric vessels to the thoracodorsal vessel. The postoperative course was uneventful in both cases. Although many anatomical studies have revealed different locations, diameters, branching patterns, and perforators of the IMA/V, absent IMV has been reported very rarely. In autologous breast reconstruction, plastic surgeons should be prepared for the possibility of the absence of IMV.
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Affiliation(s)
- Mayu Muto
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Toshihiko Satake
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yuma Masuda
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Saya Kobayashi
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shihoko Tamura
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shinji Kobayashi
- Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tohru Ohtake
- Department of Breast Surgery, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
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13
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Huang TCT, Cheng HT. One-vein vs. two-vein anastomoses utilizing the retrograde limb of the internal mammary vein as supercharge recipient vessel in free DIEP flap breast reconstruction: A meta-analysis of comparative studies. J Plast Reconstr Aesthet Surg 2020; 73:184-199. [DOI: 10.1016/j.bjps.2019.05.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
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Incidental finding of subclavian artery occlusion and subsequent hypoplastic internal mammary artery as a candidate recipient vessel in DIEP flap breast reconstruction. Arch Plast Surg 2019; 46:599-602. [PMID: 31462029 PMCID: PMC6882696 DOI: 10.5999/aps.2019.00430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/12/2019] [Indexed: 11/27/2022] Open
Abstract
We report a case of autologous breast reconstruction in which a thoracodorsal vessel was used as a recipient vessel after a hypoplastic internal mammary vessel was found on preoperative computed tomography (CT) angiography. A 46-year-old woman with no underlying disease was scheduled to undergo skin-sparing mastectomy and breast reconstruction using a deep inferior epigastric artery perforator flap. Preoperative CT angiography showed segmental occlusion of the right subclavian artery with severe atherosclerosis and calcification near the origin of the internal mammary artery, with distal flow maintained by collateral branches. The thoracodorsal artery was selected to be the recipient vessel because CT showed that it was of adequate size and was not affected by atherosclerosis. The patient experienced no postoperative complications, and the flap survived with no vascular complications. The breasts were symmetrical at a 6-month follow-up. This case highlights that preoperative vascular imaging modalities may help surgeons avoid using diseased vessels as recipient vessels in free flap breast reconstructions.
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O'Neill AC, Mughal M, Saggaf MM, Wisniewski A, Zhong T, Hofer SOP. A structured pathway for accelerated postoperative recovery reduces hospital stay and cost of care following microvascular breast reconstruction without increased complications. J Plast Reconstr Aesthet Surg 2019; 73:19-26. [PMID: 31628082 DOI: 10.1016/j.bjps.2019.06.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/16/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Accelerated recovery protocols have proved effective in many surgical procedures but are infrequently applied in breast reconstruction. In this study, we evaluate the impact of a structured pathway for accelerated postoperative recovery in patients undergoing microvascular breast reconstruction at a high-volume center. METHODS We describe our care pathway for patients undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction at our center. We compared length of stay (LOS), complication rates, readmission rates, and cost of inpatient care before (pre-protocol (Pre-P)) and after (post-protocol (Post-P)) the implementation of the protocol. RESULTS Patients in the Post-P group (n = 198) had a significant reduction in mean LOS as compared to those in the Pre-P (n = 183) group (3.6 +/- 0.85 vs. 4.7 +/-1.04 days, p = 0.006). There was no significant difference in the rates of major (Pre-P 16.9% vs. Post-P 14.7%, p = 0.71) or minor (Pre-P 21.3% vs. 17.1%, p = 0.22) postoperative complications between groups. The readmission rates were also similar (Pre-P 6.5% vs. Post-P 4.5, p = 0.69). Implementation of the protocol resulted in a significant reduction in the mean cost of in-patient care. CONCLUSION A simple protocol for accelerated and streamlined postoperative recovery effectively reduces LOS and patient care costs following DIEP flap breast reconstruction without compromising patient safety.
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Affiliation(s)
- Anne C O'Neill
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada. anne.o'
| | - Maleeha Mughal
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Moaath M Saggaf
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Agnes Wisniewski
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Toni Zhong
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
| | - Stefan O P Hofer
- Division of Plastic and Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto. Toronto General Hospital, 200 Elizabeth Street, 8N-867, Toronto, Ontario M5G 2C4, Canada
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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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Thimmappa ND, Vasile JV, Ahn CY, Levine JL, Prince MR. MRA of the skin: mapping for advanced breast reconstructive surgery. Clin Radiol 2018; 74:13-28. [PMID: 29499911 DOI: 10.1016/j.crad.2017.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/20/2017] [Indexed: 01/02/2023]
Abstract
Autologous breast reconstruction using muscle-sparing free flaps are becoming increasingly popular, although microvascular free flap reconstruction has been utilised for autologous breast reconstructions for >20 years. This innovative microsurgical technique involves meticulous dissection of artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap; however, due to unpredictable anatomical variations, preoperative imaging of the donor site to select appropriate perforators has become routine. Preoperative imaging also reduces operating time and enhances the surgeon's confidence in choosing the appropriate donor site for harvesting flaps. Although computed tomography angiography has been widely used for preoperative imaging, concerns over excessive exposure to ionising radiation and poor iodinated contrast agent enhancement of the intramuscular perforator course has made magnetic resonance angiography, the first choice imaging modality in our centre. Magnetic resonance angiography with specific post-processing of the images has established itself as a reliable method for mapping tiny perforator vessels. Multiple donor sites can be imaged in a single setting without concern for ionising radiation exposure. This provides anatomical information of more reconstruction donor site options, so that a surgeon can design a flap of tissue centralised around the best perforator, as well as a back-up perforator, and even a back-up flap option located on a different region of the body. This information is especially helpful in patients with a history of scar tissue from previous surgeries, where the primary choice perforator is found to be damaged or unsuitable intraoperatively. In addition, chest magnetic resonance angiography evaluates recipient site blood vessel suitability including vessel diameters, course, and branching patterns. In this article we provide a broad overview of various skin flaps, clinical indications, advantages and disadvantages of each of these flaps, basic imaging technique, along with advanced sequences for visualising tiny arteries in the groin and in the chest. Post-processing techniques, structure of the report and how automation of the reporting system improves workflow is described. We also describe applications of magnetic resonance angiography in postoperative imaging.
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Affiliation(s)
- N D Thimmappa
- Radiology, University of Missouri, Columbia, MO, USA.
| | - J V Vasile
- Division of Plastic and Reconstructive Surgery, Northern Westchester Hospital, Mt. Kisco, USA; New York Eye and Ear Infirmary of Mount Sinai, Plastic Surgery, New York, NY, USA
| | - C Y Ahn
- Plastic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - J L Levine
- New York Eye and Ear Infirmary of Mount Sinai, Plastic Surgery, New York, NY, USA
| | - M R Prince
- Radiology, New York-Presbyterian Hospital, Columbia University, NY, USA; Radiology, Weill Cornell Medical Center, NY, USA
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See JL, Przybylska J, MacLennan L, Malata CM. Letter to the Editor regarding "Use of both anterograde and retrograde internal mammary vessels in the bipedicled deep inferior epigastric perforator flap for unilateral breast reconstruction". J Plast Reconstr Aesthet Surg 2018; 71:431-433. [PMID: 29329744 DOI: 10.1016/j.bjps.2017.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Jia Le See
- University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Julia Przybylska
- Poznań University of Medical Sciences, Faculty of Medicine, Poznań, Poland
| | - Louise MacLennan
- Cambridge Breast Unit, Addenbrooke's University Hospital, Cambridge, UK; Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Charles M Malata
- Cambridge Breast Unit, Addenbrooke's University Hospital, Cambridge, UK; Department of Plastic and Reconstructive Surgery, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Anglia Ruskin University School of Medicine, Chelmsford & Cambridge, UK.
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Samargandi OA, Winter J, Corkum JP, Al Youha S, Frank S, Williams J. Comparing the thoracodorsal and internal mammary vessels as recipients for microsurgical autologous breast reconstruction: A systematic review and meta-analysis. Microsurgery 2017; 37:937-946. [PMID: 28949034 DOI: 10.1002/micr.30244] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/14/2017] [Accepted: 09/05/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Our aim was to determine whether the thoracodorsal (Td) vessels have comparable clinical outcomes to the internal mammary (IM) vessels as recipients for autologous free tissue transfer for breast reconstruction. METHODS Systematic searches of MEDLINE, EMBASE, CENTRAL, and World of Science from inception to June 2016 were performed by two independent reviewers. Studies that included adult females undergoing autologous free tissue transfer for breast reconstruction were selected. The two comparison groups were the use of IM or Td as recipient vessels. Our primary outcome was rate of flap survival. We assessed the methodologic quality of included studies using the JADAD and MINOR scales. RESULTS A total of 1897 patients underwent 2644 free abdominal flap tissue transfer in the 10 articles that were included in our analysis. There was one randomized controlled study (Jadad score 2/5) and 9 nonrandomized controlled studies (MINORS scores 11-19/24). There was no difference between the uses of either vessel in terms of flap loss (1.18; 95% CI 0.71-1.95). Complication rate among the IM vessels ranged from 5 to 12%, compared with 3.4-12% among Td vessels. Hematoma and seroma rates were variable. Fat necrosis was higher with Td vessels in two studies. Performing Td vessels anastomosis was associated with shorter operative time and higher risk of encountering unusable vessel. CONCLUSION Both recipient vessels are safe, reliable and demonstrate equivocal results in the absence of contraindications. Utilizing either as a first-line vessel is reasonable, depending on surgeons' preference or certain clinical scenarios. QUESTION Therapeutic, Level of evidence: III.
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Affiliation(s)
- Osama A Samargandi
- Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Plastic and Reconstructive Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jessica Winter
- Department of Surgery, Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph P Corkum
- Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Al Youha
- Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon Frank
- Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Plastic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Jason Williams
- Division of Plastic Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Determining the best recipient vessel site for autologous microsurgical breast reconstruction with DIEP flaps: An anatomical study. J Plast Reconstr Aesthet Surg 2017; 70:781-791. [PMID: 28259642 DOI: 10.1016/j.bjps.2017.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/25/2016] [Accepted: 01/31/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate. This anatomical observational study aimed to determine whether anatomy could address this dilemma by determining the best vessel diameter to match the donor with these three recipient sites. METHODS Our series reports 80 dissections of the three anatomical regions of interest. Forty formalin-preserved female cadavers were dissected bilaterally. Internal vessels diameter measurements were recorded with a vascular gauge ranging from 1.0 to 5.0 mm with successive half-millimeter graduations. RESULTS The median diameter of the deep inferior epigastric (DIEA), internal thoracic (ITA), circumflex scapular (CSA), and thoracodorsal arteries (TDA) were: 2.0, 2.5, 2.5, and 1.5 mm, respectively. The median diameter of the deep inferior epigastric, internal thoracic, circumflex scapular, and thoracodorsal veins were: 3.0, 3.0, 3.0, and 2.5 mm, respectively. At the individual level, the perfect match between DIEA and ITA was significantly more frequent than between DIEA and TDA (p = 0.002), and it was more frequent between DIEA and CSA than between DIEA and TDA (p = 0.009). CONCLUSIONS This study supports the use of the internal thoracic pedicle as the first recipient vessel choice, which should be considered, at least anatomically, as the best one with the closest diameter matching with the donor pedicle.
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Circumflex scapular vessels: A rescue strategy in case of internal mammary anastomosis failure. J Plast Reconstr Aesthet Surg 2016; 69:e227-e228. [PMID: 27639420 DOI: 10.1016/j.bjps.2016.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022]
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