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Vollbach FH, Neuss C, Siegwart LC, Bigdeli AK, Kneser U, Fansa H, Kotsougiani-Fischer D. The transverse myocutaneous gracilis flap (TMG) for breast reconstruction: ipsi vs. contralateral harvest-aesthetic outcome and refinement procedures. Breast Cancer 2023; 30:845-855. [PMID: 37392247 DOI: 10.1007/s12282-023-01478-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND The TMG flap is a popular choice for breast reconstruction. However, it remains unclear whether the side of flap harvest, subsequent flap shaping and inset impacts breast appearance and volume dispersion. This study compares the aesthetic outcome of the reconstructed breast following TMG flap harvest from the ipsilateral or contralateral thigh. PATIENT AND METHODS A retrospective matched-pair multi-center study was conducted. Patients were grouped according to the side of flap harvest (ipsilateral vs. contralateral) and matched for age, BMI and mastectomy type. Between 01/2013 and 03/2020, 384 TMG breast reconstructions were performed, of which 86 were included (43 ipsilateral vs. 43 contralateral). Standardized pre- and postoperative photographs were evaluated using a modified assessment scale comprising of a symmetry score (SymS, max. 20 points), a volume discrepancy score (VDS, max. 8 points) and an aesthetic appearance score (AS, max. 10 points). Autologous fat grafting (AFG) procedures for breast refinement were compared. RESULTS Pleasing breast symmetry (SymS Ipsi: 14.5/20; Contra: 14.9/20), volume (VDS Ipsi: 3.3/8; Contra: 2.4/8) and aesthetic appearance (AS Ipsi: 6.7/10; Contra: 6.7/10) were achieved with both surgical methods. No significant changes were present regarding the VDS (F(1.82) = 2.848, p = 0.095) or the SymS (F(1.82) = 1.031, p = 0.313) pre- to postoperatively. Significantly more autologous fat grafting was done in the contralateral group (p < 0.001). CONCLUSION The side of the TMG flap harvest, different shaping and inset techniques do not impact the aesthetic breast outcome. Both surgical methods result in pleasing breast symmetry and volume. Secondary procedures are common and should be entailed in the reconstructive strategy.
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Affiliation(s)
- Felix H Vollbach
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany.
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany.
| | - Clara Neuss
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Laura C Siegwart
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Hisham Fansa
- Department of Plastic Surgery and Breast Center, Spital Zollikerberg, Zollikerberg, 8125, Zurich, Switzerland
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Klinikum Bielefeld, OWL-University, 33604, Bielefeld, Germany
| | - Dimitra Kotsougiani-Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen, Germany
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
- Private Practice for Plastic and Aesthetic Surgery, AESTHETIKON Heidelberg and Mannheim, L9, 8, 68161, Mannheim, Germany
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Donor Site Morbidity in Unilateral and Bilateral Transverse Musculocutaneous Gracilis (TMG) Flap Breast Reconstruction: Sensation, Function, Aesthesis and Patient-Reported Outcomes. J Clin Med 2021; 10:jcm10215066. [PMID: 34768585 PMCID: PMC8584688 DOI: 10.3390/jcm10215066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
The transverse musculocutaneous gracilis (TMG) flap has become a popular choice for breast reconstruction. This study aimed to compare the donor site morbidity in unilateral and bilateral procedures. Patients receiving a TMG flap (January 2008–October 2019) were invited to a follow-up and grouped according to unilateral (UL group) or bilateral (BL group) breast reconstruction. Outcome criteria included sensation, function and aesthesis of the thighs. Patient-reported outcomes were surveyed using validated questionnaires. The number and kind of refinement procedures for aesthetic purposes on the donor thighs were evaluated. Thirty-eight patients with 59 TMG flaps were included in the study (UL group: n = 17, BL group: n = 21). Normal to slightly diminished superficial skin sensation was maintained in most of the thigh skin (98.4%). Strength and mobility were without impairment in >80% of the thighs in both groups. Thigh symmetry was achieved in both groups. Symmetrisation procedures were significantly more often performed in the UL group (p = 0.005). The total number of refinement procedures was similar in both groups. Patient-reported outcomes were similar with good appearance of the thighs and scars, excellent function and low pain levels. The TMG flap offers excellent function and sensation on the donor thigh. Thigh symmetry and good patient satisfaction may be achieved in both unilateral and bilateral breast reconstructions.
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Weitgasser L, Mahrhofer M, Schwaiger K, Bachleitner K, Russe E, Wechselberger G, Schoeller T. Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases. J Clin Med 2021; 10:jcm10163629. [PMID: 34441926 PMCID: PMC8396873 DOI: 10.3390/jcm10163629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Happy 30th birthday to the transverse myocutaneous gracilis (TMG) flap. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide. This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction. PATIENTS AND METHODS The present literature and history of the TMG flap was reviewed and a retrospective double center cohort study of 300 free TMG free flaps for autologous breast reconstruction was conducted. Patient demographics, perioperative data, and post-operative complications were recorded and compared with literature findings. RESULTS Mean flap weight was 320 g. Mean pedicle length was 70 mm. Complications included 19 (6.3%) flap loss. 10 patients (3.3%) had postoperative cellulitis and 28 (9.3%) wound healing disturbance of the donor site. CONCLUSION Recipient and donor site complications were comparable to other free flaps used for breast reconstruction. A low BMI or the lack of an abdominal based donor site do not represent a limitation for breast reconstruction and can be overcome using the TMG flap.
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Affiliation(s)
- Laurenz Weitgasser
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 72074 Tübingen, Germany; (M.M.); (K.B.); (T.S.)
- Correspondence:
| | - Maximilian Mahrhofer
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 72074 Tübingen, Germany; (M.M.); (K.B.); (T.S.)
| | - Karl Schwaiger
- Department of Plastic and Reconstructive Surgery, Hospital of the Brothers of St. John of God (Barmherzige Brüder), Paracelsus Medical University, 5020 Salzburg, Austria; (K.S.); (E.R.); (G.W.)
| | - Kathrin Bachleitner
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 72074 Tübingen, Germany; (M.M.); (K.B.); (T.S.)
| | - Elisabeth Russe
- Department of Plastic and Reconstructive Surgery, Hospital of the Brothers of St. John of God (Barmherzige Brüder), Paracelsus Medical University, 5020 Salzburg, Austria; (K.S.); (E.R.); (G.W.)
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Hospital of the Brothers of St. John of God (Barmherzige Brüder), Paracelsus Medical University, 5020 Salzburg, Austria; (K.S.); (E.R.); (G.W.)
| | - Thomas Schoeller
- Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart, Teaching Hospital of the Eberhard Karls University, 72074 Tübingen, Germany; (M.M.); (K.B.); (T.S.)
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Siegwart LC, Bolbos A, Tapking C, Seide SE, Diehm Y, Fischer S, Kneser U, Kotsougiani-Fischer D. Safety and donor site morbidity of the transverse musculocutaneous gracilis (TMG) flap in autologous breast reconstruction-A systematic review and meta-analysis. J Surg Oncol 2021; 124:492-509. [PMID: 34091906 DOI: 10.1002/jso.26559] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/22/2021] [Accepted: 05/22/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The transverse musculocutaneous gracilis (TMG) flap has gained popularity for breast reconstruction. However, the literature regarding its donor site morbidity is heterogeneous. This systematic review sought to clarify the evidence on donor site morbidity. METHODS A systematic literature search was conducted. We included all articles reporting on donor-site morbidity of the TMG flap for breast reconstruction. The results were analyzed in R and its extension meta. A generalized linear mixed model was used to combine proportions and their 95% confidence intervals (CIs) in a random-effects meta-analysis. RESULTS Nineteen articles provided an overall sample of 843 TMG flaps. The total flap loss was low at 2% (95% CI, 1%-3%). All patients were normal weight (pooled body mass index 22.75, 95% CI, 21.88-23.63). The incidence of wound dehiscence (8%, 95% CI, 4%-16%), seroma (4%, 95% CI, 2%-7%), hematoma (2%, 95% CI, 1%-4%) and infection (0%-5%) on the TMG donor site was low. Functional impairments included sensory disturbance (0%-74%), motoric deficits (0%-50%), and changes in the genital region (0%-24%), all of which were modest. CONCLUSIONS This review confirms the safety and low donor site morbidity of the TMG flap in normal-weight patients, which is comparable to that of other popular free flaps in breast reconstruction.
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Affiliation(s)
- Laura Cosima Siegwart
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Anca Bolbos
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Svenja E Seide
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Yannick Diehm
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany.,Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sebastian Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
| | - Dimitra Kotsougiani-Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwigshafen, Germany
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Opsomer D, Vyncke T, Depypere B, Stillaert F, Blondeel P, Van Landuyt K. Lumbar Flap versus the Gold Standard. Plast Reconstr Surg 2020; 145:706e-714e. [DOI: 10.1097/prs.0000000000006681] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Russe E, Kholosy H, Weitgasser L, Brandstetter M, Traintinger H, Neureiter J, Wechselberger G, Schoeller T. Autologous fat grafting for enhancement of breast reconstruction with a transverse myocutaneous gracilis flap: A cohort study. J Plast Reconstr Aesthet Surg 2018; 71:1557-1562. [PMID: 30213746 DOI: 10.1016/j.bjps.2018.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/28/2018] [Accepted: 07/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The transverse myocutaneous gracilis (TMG) flap is a viable option for the reconstruction of small- to moderate-sized breasts. The purpose of this series was to examine the outcomes of fat grafting to breast and donor site secondary to breast reconstruction with a TMG flap. METHODS A cohort study was conducted to identify all patients who underwent autologous fat grafting after breast reconstruction with a TMG flap at two institutions between January 2009 and October 2013. Data were collected regarding patient demographics, body mass index, and medical history as well as surgical details regarding TMG flap surgery and fat grafting. RESULTS A total of 145 fat graftings were performed in 83 patients following TMG flap breast reconstruction to improve the contour, shape, and volume of breasts (98%, n = 142), donor site (9%, n = 13) or both (7%, n = 10), mainly after breast cancer surgery (83%). On average, 1.8 fat grafting sessions were performed with an average of 30cc fat per breast and 56.4cc fat per thigh. In 72% of patients, fat injection was performed by other pending reconstructive procedures. Fat was harvested by the tumescent technique, by using a filter syringe system, and injected without any further processing in multiple layers. CONCLUSIONS Autologous fat grafting as a secondary procedure represents a powerful adjunct to enhance the aesthetic outcome of the reconstructed breast and donor site. It can be easily combined with other pending reconstructive procedures. With additional fat grafting, it may be possible to expand indications and offer autologous reconstruction with a TMG flap even in very lean patients.
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Affiliation(s)
- Elisabeth Russe
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria.
| | - Hassan Kholosy
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria; Department of Plastic Surgery, Faculty of Medicine, Alexandria University, 1 Champlion Street, 21131 Alexandria, Egypt
| | - Laurenz Weitgasser
- Department of Hand-, Breast-, and Reconstructive Microsurgery, Marienhospital Stuttgart, Böheimstraβe 37, 70199 Stuttgart, Stuttgart, Germany
| | - Michael Brandstetter
- Department of Hand-, Breast-, and Reconstructive Microsurgery, Marienhospital Stuttgart, Böheimstraβe 37, 70199 Stuttgart, Stuttgart, Germany
| | - Heike Traintinger
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria; Department of Hand-, Breast-, and Reconstructive Microsurgery, Marienhospital Stuttgart, Böheimstraβe 37, 70199 Stuttgart, Stuttgart, Germany
| | - Jennifer Neureiter
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Thomas Schoeller
- Department of Hand-, Breast-, and Reconstructive Microsurgery, Marienhospital Stuttgart, Böheimstraβe 37, 70199 Stuttgart, Stuttgart, Germany
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Marquez MDLP, Fernandez-Riera R, Cardona HV, Flores JMR. Immediate implant replacement with DIEP flap: a single-stage salvage option in failed implant-based breast reconstruction. World J Surg Oncol 2018; 16:80. [PMID: 29665804 PMCID: PMC5905049 DOI: 10.1186/s12957-018-1387-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/10/2018] [Indexed: 11/23/2022] Open
Abstract
Background Implant-based immediate breast reconstruction after skin-sparing mastectomy has shown a significant improvement in patients’ quality of life, making the procedure steadily more popular year after year. However, this technique has a high morbidity rate, including skin necrosis and implant exposure. Methods A retrospective review of a prospectively held database for autologous breast reconstruction in our institution of the last 5 years found eight cases with exposed implants after nipple-sparing mastectomy and immediate reconstruction. A single-stage procedure consisting on implant removal and immediate replacement with a deepithelialized DIEP flap was performed in all cases (10 DIEP flaps). Results All flaps were successful. Patients’ mean age was 45 years old. Three patients developed seroma (5, 7, and 14 days after surgery, respectively). No infections were detected in up to 24 months of follow-up. Conclusions Nipple-sparing mastectomy with immediate implant-based reconstruction is considered oncologically safe. However, it has a high rate of complications that could require implant removal. Immediate free flap reconstruction is a feasible and safe option to replace the missing volume with low risk of complications that result in a soft and natural-shaped breast.
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Affiliation(s)
- Miguel De La Parra Marquez
- Division of Plastic and Reconstructive Surgery, Mexican Institute of Social Security (IMSS), No. 21 Pino Suárez y 15 de Mayo, Av. Hidalgo 2480 pte, col. Obispado. C.p.64060. Cons. 212, Monterrey Nuevo León, Mexico.
| | - Ricardo Fernandez-Riera
- Department of Plastic and Reconstructive Surgery, Hospital General Dr. Ruben Leñero, Plan de San Luis esq Salvador Díaz Mirón SN, Col. Santo Tomás. Deleg. Miguel Hidalgo. Cp. 11340. CDMX, Mexico City, Mexico
| | - Hector Vela Cardona
- Division of Plastic and Reconstructive Surgery, Mexican Institute of Social Security (IMSS), No. 21 Pino Suárez y 15 de Mayo, Av. Hidalgo 2480 pte, col. Obispado. C.p.64060. Cons. 212, Monterrey Nuevo León, Mexico
| | - Jesus María Rangel Flores
- Division of Plastic and Reconstructive Surgery, Mexican Institute of Social Security (IMSS), No. 21 Pino Suárez y 15 de Mayo, Av. Hidalgo 2480 pte, col. Obispado. C.p.64060. Cons. 212, Monterrey Nuevo León, Mexico
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Bodin F, Dissaux C, Dupret-Bories A, Schohn T, Fiquet C, Bruant-Rodier C. The transverse musculo-cutaneous gracilis flap for breast reconstruction: How to avoid complications. Microsurgery 2015; 36:42-8. [PMID: 25732779 DOI: 10.1002/micr.22394] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 01/27/2015] [Accepted: 02/16/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The transverse musculocutaneous gracilis (TMG) flap has become a common solution for breast reconstruction. However, the safe skin paddle limits are not yet understood. In this study, we attempted to address this issue based on our experiences with inferior and posterior skin paddle extension. METHODS Forty-four breast reconstructions with TMG flaps performed between November 2010 and January 2014 were analyzed retrospectively. For the first 20 cases, the flap skin paddle was extended 3 cm posteriorly to the middle thigh (group 1). For the next 20 flaps (group 2), the posterior tip was limited to this line, whereas more fat was recruited inferiorly. In the four cases of group 3, the skin flap was extended posteriorly with a second vascular pedicle from the profunda artery perforator (PAP) flap. The weights and the dimensions of the flaps, operating durations, and postoperative complications of the entire series were analyzed. Groups 1 and 2 were statistically compared. RESULTS Flap complications were statistically more frequent in group 1 compared with group 2 (45 vs. 0%, P = 0.0012); 40% posterior flap tip necrosis was observed in group 1. Conversely, donor site complications were statistically more frequent in group 2 than in group 1 (40 vs. 5%, P = 0.019) with 35% inner thigh dehiscence. In the TMG with extended PAP flap group, the operating duration was 77 min longer compared with the rest of the series with no donor site complications. In one case, limited necrosis occurred at the anterior skin tip. CONCLUSIONS Harvesting the posterior portion of the TMG up to the middle of the posterior thigh may lead to partial flap necrosis. Extending subcutaneous fat removal under the inferior skin incision may increase the risk of donor site complications. Adding a second vascular pedicle from the PAP flap may improve posterior TMG tip perfusion at the expense of a longer operation.
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Affiliation(s)
- Frédéric Bodin
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Caroline Dissaux
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Agnes Dupret-Bories
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Thomas Schohn
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
| | - Caroline Fiquet
- Department of Plastic Surgery, Strasbourg Academic Hospital, Strasbourg, France
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