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Tanna N, Sultan DL, Minasian RA, Clappier M, Haddock NT, Chrysopoulo MT, Nahabedian MY, Serletti JM, Allen RJ. Contemporary Microsurgical Breast Reconstruction: Abdominally Based Flaps. Plast Reconstr Surg 2024; 154:199e-214e. [PMID: 38923931 DOI: 10.1097/prs.0000000000011373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the types of abdominally based flaps, their anatomy, and their drawbacks. 2. Understand important aspects of the history and physical examination of patients wishing to undergo these procedures. 3. Understand the benefits of preoperative planning and its role in avoiding complication. 4. Understand the operative steps of the procedures and tips to increase efficiency. 5. Understand the postoperative care of these patients and the role of enhanced recovery pathways. SUMMARY In this article, the authors review the history, current state, and future directions related to abdominally based microsurgical breast reconstruction. This article covers preoperative, intraoperative, and postoperative considerations intended to improve patient outcomes and prevent complications. Evidence-based findings are reported when available to comprehensively review important aspects of these procedures.
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Affiliation(s)
- Neil Tanna
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Darren L Sultan
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Raquel A Minasian
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Mona Clappier
- From the Division of Plastic and Reconstructive Surgery, Northwell Health, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | | | | | | | - Joseph M Serletti
- Division of Plastic and Reconstructive Surgery, University of Pennsylvania
| | - Robert J Allen
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health
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Yoshimatsu H, Nakatsuka K, Karakawa R, Fuse Y, Yano T. The Piggyback Superficial Circumflex Iliac Perforator Flap for Complex Free Flap Reconstructions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5899. [PMID: 38911576 PMCID: PMC11191033 DOI: 10.1097/gox.0000000000005899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/24/2024] [Indexed: 06/25/2024]
Abstract
This article introduces a reproducible strategy for complex reconstruction scenarios that require the use of two flaps. It specifically focuses on the utilization of the superficial circumflex iliac artery perforator (SCIP) flap as a secondary flap, particularly in complex cases where available arterial options are limited. In the first scenario, the SCIP flap is elevated simultaneously during elevation of a fibula bone flap. The pedicle of the fibula flap will be anastomosed to the recipient vessels, and the pedicle artery of the SCIP flap, the superficial circumflex iliac artery, will be anastomosed to the distal end of the peroneal artery. The SCIP flap pedicle offers greater length compared with a cutaneous flap sourced from the peroneal artery, thus providing increased flexibility for the flap inset. In the second scenario, the SCIP flap is combined with the anterolateral thigh (ALT) flap to manage a significant defect. The pedicle of the ALT flap is anastomosed to the recipient vessels, and the superficial circumflex iliac artery is anastomosed to the distal end of the pedicle artery of the ALT flap, the descending branch of the lateral circumflex femoral artery. The SCIP flap can be harvested simultaneously with a fibula flap or an ALT flap from the same side, and its arterial anastomosis can always be established with the distal ends of the arterial pedicle of these two flaps. This efficient and reproducible method can also contribute to minimal donor site morbidity and will be particularly valuable in settings where recipient artery choices are limited.
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Affiliation(s)
- Hidehiko Yoshimatsu
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kengo Nakatsuka
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryo Karakawa
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuma Fuse
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomoyuki Yano
- From the Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Bucher F, Vogt PM, Krezdorn N, Dastagir K. Free Tissue Transfer for Reconstruction After Bilateral Skin Sparing Mastectomy-A Systematic Review. Ann Plast Surg 2024; 92:469-473. [PMID: 38470816 DOI: 10.1097/sap.0000000000003828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Breast cancer is the most commonly diagnosed malignant neoplasia in females worldwide. Overall survival and patients' choice for bilateral mastectomy have increased. It is therefore important to offer breast reconstructive procedures to improve patient quality of life and self-esteem. The aim of this systematic literature review is to quantify the outcome and sustainability of bilateral breast reconstruction using autologous, vascularized free tissue transfer. METHODS A systematic literature review of PubMed, Cochrane, and the Web of Science databases was performed. A total of 5879 citations were identified, and 12 studies met the inclusion criteria. RESULTS A total of 1316 patients were included, with a mean age of 47.2 years. Overall, 32.5% of patients experienced a complication after breast reconstruction. If reported, 7.45% of patients experienced major complications, while 20.7% had minor complications.The following flaps were used for breast reconstruction, in order of reducing frequency: DIEP (45.45%), TRAM (22.73%), SIEA (9.09%), SGAP (9.09%), TUG (4.55%), TMG (4.55%), and LD/MLD (4.55%). CONCLUSIONS Current studies indicate that bilateral breast reconstruction using autologous, vascularized free tissue transfer is a safe procedure for postmastectomy reconstruction and offers stable long-term results. This is particularly in comparison to implant-based breast reconstruction.
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Affiliation(s)
- Florian Bucher
- From the Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
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Wen YE, Steppe C, Teotia SS, Haddock NT. Operative Time Predicts Long-Term Abdominal Morbidity and Complication Requiring Treatment after DIEP Flap Breast Reconstruction. J Reconstr Microsurg 2024; 40:217-226. [PMID: 37467772 DOI: 10.1055/a-2133-1018] [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] [Indexed: 07/21/2023]
Abstract
BACKGROUND The relationship between skin-to-skin operative time and long-term complications, as well as complications requiring treatment, after deep inferior epigastric perforator (DIEP) flap breast reconstructions has not been thoroughly investigated. The study objective was to evaluate if operative time would independently prognosticate the type and number of treated complications, as well as long-term abdominal morbidity. METHODS Patients who underwent bilateral DIEP flaps from 2010 to 2021 by two senior surgeons with standardized surgical and postoperative protocols were retrospectively reviewed. Inclusion required at least 1 year of postoperative follow-up. Extensive multivariable regression analyses were utilized to adjust for potential confounders, including measures of intraoperative complexity. RESULTS Three hundred thirty-five patients were entered into multivariable analyses. After risk adjustment, there was a significant increase in the risk of all treated complications per hour. Each hour of operation increased risk of complications requiring extended hospital stay for treatment by 25%, flap-site complications requiring readmission treatment by 24%, and flap-site complications requiring extended hospital stay for treatment by 26% (all p < 0.0001). Long-term abdominal morbidity (abdominal bulge) increased by 25% per hour of operative time (p < 0.0001). The number of complications requiring treatment, abdominal donor-site complications, and complications requiring extended hospital stay for treatment had statistically significant linear relationships with the duration of surgery (all p < 0.05). CONCLUSION Operative time predicts long-term abdominal morbidity and complications requiring treatment, especially impacting the odds of developing abdominal bulges and complications requiring extended hospital stay for treatment or readmission treatment. This study emphasizes the importance of reducing operative time to improve DIEP flap breast reconstruction outcomes.
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Affiliation(s)
- Y Edward Wen
- University of Texas Southwestern Medical Center, Medical School, Dallas, Texas
| | - Cyrus Steppe
- University of Texas Southwestern Medical Center, Medical School, Dallas, Texas
| | - Sumeet S Teotia
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Nicholas T Haddock
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Changchien CH, Fang CL, Hsu CH, Yang HY, Lin YL. Creating a context for recipient vessel selection in deep inferior epigastric perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 84:618-625. [PMID: 37453149 DOI: 10.1016/j.bjps.2023.06.049] [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: 03/24/2023] [Revised: 05/27/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In autologous tissue breast reconstruction, recipient vessels are important for artery perfusion and venous drainage to ensure free flap survival. There are insufficient clinical outcomes to select efficient recipient vessels in bi-pedicled deep inferior epigastric perforator (DIEP) flap reconstruction. METHODS We presented a retrospective observational series of 108 patients regarding the diameter, anastomosis time, and re-anastomosis rate in internal mammary (IM), circumflex scapular (CS), thoracodorsal (TD), thoracoacromial (TA), lateral thoracic (LT), and internal mammary perforator (IMP) vessels of bi-pedicled DIEP flaps for breast reconstruction after mastectomy. The outcomes were the vessel re-anastomosis rate, flap failure rate, vessel anastomosis time, and complications. Data were gleaned from the chi-square test, Fisher's test, and analysis of variance using Scheffe's test as a post hoc analysis. The level of significance was p < 0.05. RESULTS There were no significant differences in the diameters of the artery, first vein, and second vein across the recipient vessels (p > 0.05). However, the anastomosis time was longer in IM and TA than in CS, TD, and LT (p < 0.001). Also, there were no significant differences for re-anastomosis, flap necrosis, and fat necrosis among different recipient vessels (p > 0.05). CONCLUSIONS Because of the altered mastectomy incisions, this study provides complete anatomical vascular properties and suggests that altering recipient vessel selection for bi-pedicled DIEP flaps can shorten anastomosis time and better conceal scars.
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Affiliation(s)
- Chih-Hsuan Changchien
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medical and Health Science, Asia University, Taichung City, Taiwan.
| | - Chien-Liang Fang
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung City, Taiwan.
| | - Chin-Hao Hsu
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.
| | - Hsin-Yi Yang
- Clinical Medical Research Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.
| | - Yi-Ling Lin
- Division of Plastic and Reconstruction Surgery, Department of Surgery, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.
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Cheng S, Wang A, Ding H, Ding J, Wang L, Gao W. High-pressure infusion improves multi-territory perforator flap viability via choke artery dilation: A preliminary study in a rat model. J Plast Reconstr Aesthet Surg 2023; 84:505-513. [PMID: 37418849 DOI: 10.1016/j.bjps.2023.06.002] [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: 12/21/2022] [Revised: 04/25/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Multi-territory perforator flaps have become the preferred option for the repair and reconstruction of large soft tissue defects. Although methods (e.g., pharmacological agents, mechanical stimulation, and thermal stimulation) were developed to open choke vessels to improve flap survival, the flap necrosis rate is still as high as 28.8%. The authors hypothesized that high-pressure infusion might enhance flap viability by dilating choke arteries intraoperatively in a rat model of multi-territory perforator flap. METHODS Two-month-old male Sprague-Dawley rats were randomized into two groups (n = 32 each). During the multi-territory perforator flap elevation based on the right superficial epigastric angiosome, one group received continuous high-pressure infusion (mean pressure, 250 mmHg; duration, 1 min) of an isotonic heparin sodium solution (12,500 U/L) via the artery in the pedicle, whereas the other group received no infusion. At 7 days postoperatively, arteriography was performed; endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) expression and microvascular density were evaluated by western blot and histology, respectively; and flap survival was compared. Moreover, intraluminal diameters were examined at 1 day and 7 days postoperatively using hematoxylin and eosin staining, and coagulation function was assessed immediately postoperatively. RESULTS High-pressure infusion significantly promoted the dilation of choke arteries at 1 day and 7 days postoperatively. It also increased eNOS and VEGF expression, flap survival, and microvascular density. The coagulation function remained unaffected. CONCLUSIONS High-pressure infusion allowed intraoperative and postoperative dilation of the choke arteries that enhanced the viability of multi-territory perforator flaps in rats.
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Affiliation(s)
- Sheng Cheng
- Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China; Department of Second Clinical Medical, the Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Anyuan Wang
- Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China
| | - Hongfeng Ding
- Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China; Department of Second Clinical Medical, the Second Clinical Medical College of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Jian Ding
- Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China
| | - Long Wang
- Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China
| | - Weiyang Gao
- Department of Orthopaedics, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China; Department of Orthopedics, Zhejiang Provincial Key Laboratory of Orthopedics, Wenzhou, Zhejiang 325000, China.
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Onoda S, Satake T, Katsuragi R, Kobayashi K, Tsukura K, Tachibana G. Relationship between rib cartilage resection and postoperative chest recession deformity in breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 83:448-454. [PMID: 37315492 DOI: 10.1016/j.bjps.2023.04.083] [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: 01/27/2023] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
AIM The most versatile recipient vessels for breast reconstruction are the internal mammary artery and vein. For microvascular anastomosis, one or two costal cartilages are often dissected to increase the length of the vessel and the degree of freedom. In some cases, the resection of the rib cartilage causes long-term depression at the dissected site, compromising its cosmetic appearance. PATIENTS AND METHODS A total of 101 patients were examined, with 111 sides in which the internal mammary artery and vein were used as the recipient vessels. The patients were followed up for at least 6 months. RESULTS A total of 37 of 38 patients with complete rib cartilage preservation had no depression, and 1 patient had a slight depression. In the case of partial resection of the rib cartilage, 37 of the 46 sides had no depression, 8 sides had mild depression, and 1 side had an obvious depression. When more than one rib cartilage was removed, 11 of the 27 sides had no depression, 11 had mild depression, and 5 had an obvious depression. The Spearman rank correlation coefficient was 0.4911936. CONCLUSION This study reported the relationship between rib cartilage resection and postoperative concave deformity in breast reconstruction surgery using free flap transfer and the internal mammary artery and vein as the recipient vessels. A strong correlation was found between the extent of rib cartilage resected and the degree of depression. Minimizing rib cartilage resection when using the internal mammary artery and veins may minimize postoperative chest recession deformity and provide a well-dressed breast reconstruction.
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Affiliation(s)
- Satoshi Onoda
- Department of Plastic and Reconstructive, Aesthetic Surgery, Toyama University Hospital, Toyama, Japan.
| | - Toshihiko Satake
- Department of Plastic and Reconstructive, Aesthetic Surgery, Toyama University Hospital, Toyama, Japan
| | - Ryohei Katsuragi
- Department of Plastic and Reconstructive, Aesthetic Surgery, Toyama University Hospital, Toyama, Japan
| | - Kohta Kobayashi
- Department of Plastic and Reconstructive, Aesthetic Surgery, Toyama University Hospital, Toyama, Japan
| | - Kahori Tsukura
- Department of Plastic and Reconstructive, Aesthetic Surgery, Toyama University Hospital, Toyama, Japan
| | - Gaku Tachibana
- Department of Plastic and Reconstructive, Aesthetic Surgery, Toyama University Hospital, Toyama, Japan
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Jaiswal D, Mathews S, Gupta H, Shankhdhar VK, Mantri M, Bindu A, Pilania V, Yadav P. Utilizing the Retrograde Flow of Internal Mammary Vessels as a Donor Pedicle. Indian J Plast Surg 2022; 55:244-250. [PMID: 36325086 PMCID: PMC9622219 DOI: 10.1055/s-0042-1750377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction
The aim of this study is to assess the results of retrograde flow of internal mammary artery and vein (IMA/V) as a donor vessel for free flap microvascular anastomosis (MVA). This need arises with bipedicle deep inferior epigastric perforator (DIEP) flaps, when all four zones with extra fat need to be harvested for unilateral breast reconstruction coupled with poor midline crossover of circulation naturally or because of midline scar. Large anterolateral thigh flaps for chest wall cover, with multiple perforators from separate pedicles, also need supercharging. This needs an additional source of donor vessels, antegrade IMA/V being the first one.
Materials and Methods
Retrospective study of microvascular breast reconstruction using retrograde internal mammary donor vessels.
Results
Out of 35 cases, 20 cases had distal IMA/V, with retrograde flow, as donor vessel for second set of arterial and venous anastomosis. In two cases, retrograde IMA/V was used for the solitary set of MVA. In remaining 13 cases, either retrograde IMA or V was utilized either as a principal or accessory donor. No flap was lost. Venous and arterial insufficiency happened in one case each, both were salvaged. Two cases developed partial necrosis, needing debridement and suturing. One case developed marginal necrosis. Only one case developed fat necrosis with superadded infection on follow-up.
Conclusion
Distal end of IMA and IMV on retrograde flow is safe for MVA as an additional or sole pedicle. It is convenient to use being in the same field. It enables preservation of other including thoracodorsal pedicle and latissimus dorsi flap for use in case of a complication or recurrence.
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Affiliation(s)
- Dushyant Jaiswal
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Saumya Mathews
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Himanshu Gupta
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vinay Kant Shankhdhar
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mayur Mantri
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ameya Bindu
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vineet Pilania
- Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prabha Yadav
- Department of Plastic and Reconstructive Surgery, H. N. Reliance Hospital, Mumbai, Maharashtra, India
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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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Palve JS, Luukkaala TH, Kääriäinen MT. Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels. JOURNAL OF RECONSTRUCTIVE MICROSURGERY OPEN 2021. [DOI: 10.1055/s-0041-1729638] [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] Open
Abstract
Abstract
Background The aim of this study is to analyze the impact of the number and location of perforators harvested and the recipient vessels used on deep inferior epigastric perforator (DIEP) flap survival and the occurrence of flap necrosis requiring re-operation.
Patients and Methods Four hundred and seventy-one DIEP flap reconstructions, performed between January 2008 and December 2019, were retrospectively analyzed.
Results Flap necrosis requiring re-operation was observed in 40 (9%) of flaps and total flap loss rate was 1% (n = 6). No significant differences were observed between internal mammary vessels (IMV, n = 287, 61%) and thoracodorsal vessels (TDV, n = 184, 39%) regarding postoperative re-anastomosis (p = 0.529) or flap survival (p = 0.646). Intraoperative conversion from IMV to TDV was performed on 64 (14%) patients. TDV were more commonly associated with problems in preparation of the vessels than IMV (p < 0.001). Second vein anastomosis was performed on 18 (4%) patients. In total, 81 flaps (17%) had one perforator, 165 (35%) had two, 218 (46%) had three to five, and 7 (2%) had more than five perforators. Flaps with three to five perforators were more commonly associated with flap necrosis (p < 0.001) than flaps with one or two perforators. Independent factors associated with necrosis were body mass index (BMI) > 30 (odds ratio [OR]: 2.28; 95% confidence interval: 1.06–4.91, p = 0.035) and perforator/s located on the lateral row (OR: 3.08, 95% CI 1.29–7.33, p = 0.011).
Conclusion We conclude that the occurrence of flap necrosis requiring re-operation may be higher in DIEP flaps with more than two perforators or perforator/s located on the lateral row and in obese patients. Neither the recipient vessels used nor the number of perforators harvested had any impact on the flap survival rate.
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Affiliation(s)
- Johanna S. Palve
- Department of Plastic Surgery, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
| | - Tiina H. Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital and Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Minna T. Kääriäinen
- Department of Plastic Surgery, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
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