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Chakari W, Bille C, Lilja C, Thomsen JB. Combined perforator flaps for total breast reconstruction-a narrative review and insights from massive weight loss cases. Gland Surg 2024; 13:760-774. [PMID: 38845826 PMCID: PMC11150200 DOI: 10.21037/gs-23-397] [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: 09/20/2023] [Accepted: 03/25/2024] [Indexed: 06/09/2024]
Abstract
Background and Objective Perforator flaps have revolutionized autologous breast reconstruction, introducing both free and pedicled options as well as the potential for combining flaps. These versatile techniques can be utilized in massive weight loss (MWL) patients, effectively addressing both functional and aesthetic challenges by using their excess skin. This review aims to explore literature on combined pedicled and free perforator flaps for total breast reconstruction, and share our own experience in the field. Methods A PubMed search up to June 2023 employed Medical Subject Headings (MeSH) terms such as (("combined") OR ("stacked") OR ("conjoined") AND ("perforator flaps")) AND ("breast reconstruction"). Publications in English and Scandinavian languages were manually screened for relevance, and supplemental sources were also reviewed. Key Content and Findings Limited studies exist on using combined pedicled and free flaps for total breast reconstruction, although combined free flaps are more common. Perforators around the breast base, offer multiple flap options for single or combined use. In our series of 10 women, four underwent total breast reconstruction with a combination of flip-over internal mammary artery perforator (IMAP) flap and thoracodorsal artery perforator (TDAP) flap. Another subset of four, who were MWL patients, received combined TDAP and superior epigastric artery perforator (SEAP) flaps, along with body contouring procedures such as upper body lifts and vertical abdominoplasties, addressing excess skin and improving silhouette. One remaining MWL patient had deflated breasts restored using TDAP and SEAP flaps, along with an upper and lower body lift and vertical abdominoplasty. The last MWL patient underwent a risk-reducing mastectomy, also reconstructed with TDAP and SEAP flaps, and received an upper body lift and vertical abdominoplasty. Conclusions Combined perforator flap techniques for combined body contouring and breast reconstruction seems safe and especially suitable for MWL patients. They offer a surgical alternative merging body contouring and breast reconstruction in cases where free flap procedures seem less favorable due to skin laxity and deflation of donor sites. However, limited literature on the topic calls for further studies.
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Affiliation(s)
- Wahida Chakari
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Research Unit for Plastic Surgery, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Research Unit for Plastic Surgery, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Caroline Lilja
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Research Unit for Plastic Surgery, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Research Unit for Plastic Surgery, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Marchica P, Oieni S, David M, Coppola F, Rossi M, Cammarata E, Cordova A, Gebbia V, D'Arpa S. Latissimus Dorsi Flap and Thoracodorsal Artery Perforator Flap with Immediate Fat Transfer (LIFT and TIFT): A Retrospective Study about Total Breast Reconstruction in High-Risk Patients. Aesthetic Plast Surg 2024; 48:1745-1758. [PMID: 37580568 DOI: 10.1007/s00266-023-03528-3] [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: 04/02/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Microsurgical breast reconstruction has become popular over the past twenty years and allows a tailor-tuck approach to each patient. However, smoking or coagulation disorders may switch surgeon's choice towards alternative options. When facing these risk factors, we performed pedicled latissimus dorsi (LD) flap and thoracodorsal artery perforator (TDAP) flap reconstruction with immediate fat transfer (LIFT and TIFT), achieving satisfactory surgical outcomes. Hence, we aim to present our seven-years case-series and discuss our decisional algorithm. MATERIALS AND METHODS Thirty smoker women and seven women affected by coagulation disorder (n = 37) respectively had LIFT and TIFT surgery and were retrospectively evaluated. Patients' demographics and outcomes were recorded and compared. RESULTS LIFT patients received higher volumes of immediate fat grafting compared to TIFT patients (p < 0.05), which required additional lipofilling to provide adequate volume amount, since the TDAP flap was not immediately grafted. However, the additional lipofilling procedures and fat volume were similar (p > 0.05). Flap survival reached 100%, and flap necrosis or loss did not occur. Few minor complications were evidenced in the LIFT group only (p > 0.05). CONCLUSION Based on our experience, we support the reliability of pedicled LD and TDAP flaps with immediate fat transfer in breast reconstruction as valuable alternative to microsurgery in smokers (LIFT) and patients with coagulation disorders (TIFT). However, the results of our study are not conclusive since still must be clarified the role of the smoking and coagulation disorders in microsurgery and the real benefit of a non-microsurgical procedure. LEVEL OF EVIDENCE IV Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Paolo Marchica
- Department of Plastic and Reconstructive Surgery, Treviso General Hospital, Piazzale dell'Ospedale, 1, 31100, Treviso, Italy.
| | - Sebastiano Oieni
- Plastic Surgery and Breast Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Massimo David
- Breast Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Federico Coppola
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Matteo Rossi
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Emanuele Cammarata
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Vittorio Gebbia
- Department of Medical Oncology, University of Enna "Kore", Enna, Italy
| | - Salvatore D'Arpa
- Plastic Surgery and Breast Unit, La Maddalena Cancer Center, Palermo, Italy
- Residency School in Plastic and Reconstructive Surgery, International University of Goražde, Goražde, Bosnia and Herzegovina
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Barbat P, Hu W, Rouanet M, Claudic Y, Henry AS. [Unilateral secondary breast reconstruction using a pedicled dorsal flap sparing the latissimus dorsi (TDAP and MSLD) in patients with a history of total mastectomy for breast cancer. Monocentric observational study]. ANN CHIR PLAST ESTH 2024; 69:136-153. [PMID: 38065785 DOI: 10.1016/j.anplas.2023.11.004] [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: 11/02/2023] [Accepted: 11/18/2023] [Indexed: 02/26/2024]
Abstract
INTRODUCTION The use of pedicled dorsal flaps sparing the latissimus dorsi muscle (TDAP and MSLD flap) is a well-described reconstruction method in breast reconstruction after breast cancer. However, little data exists regarding patient satisfaction after this surgery. The main objective of this study was to evaluate patient satisfaction after unilateral total secondary breast reconstruction using a TDAP or MSLD flap. The secondary objectives corresponded to the evaluation of postoperative complications following this surgery, the evaluation of the duration of the reconstruction and the nature of additional interventions, the evaluation of the functional after-effects, and the evaluation of the chest size when the reconstruction is completed. MATERIAL AND METHOD This is a monocentric, retrospective cohort study, including 22 patients who underwent unilateral secondary total breast reconstruction using a TDAP or MSLD flap between January 1, 2018 and December 31, 2022. Patient satisfaction was assessed using three questionnaires validated in breast reconstruction: the Reconstruction module of the BREAST-Q, the MBROS-S and the MBROS-BI. RESULTS The MBROS-S satisfaction score is 71.4%. The MBROS-BI body image score is 62%. With the BREAST-Q, the Satisfaction with Breast score is estimated at 53.1; the Satisfaction with Back score is estimated at 75.5; the physical well-being score regarding the chest is evaluated at 71.7; the physical well-being score concerning the shoulder and back is evaluated at 67.4; the psychosocial well-being score is assessed at 67.4; the sexual well-being score is estimated at 48.7; and for women who have benefited from reconstruction associated with a prosthesis, the satisfaction score regarding the implant is 71.6. CONCLUSION Unilateral total secondary breast reconstruction with a dorsal pedicled flap sparing the latissimus dorsi muscle is an elegant, reliable, and respectful way to reconstruct a breast, and appears to give high levels of satisfaction.
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Affiliation(s)
- P Barbat
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France.
| | - W Hu
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - M Rouanet
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - Y Claudic
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - A-S Henry
- Service de chirurgie plastique, reconstructrice et esthétique, CHRU de la Cavale Blanche de Brest, université de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
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Visconti G, Bianchi A, Di Leone A, Franceschini G, Masetti R, Salgarello M. The Ultrasound Evolution of Lateral Thoracic Perforator Flaps Design and Harvest for Partial and Total Breast Reconstruction. Aesthetic Plast Surg 2024; 48:894-904. [PMID: 36517641 DOI: 10.1007/s00266-022-03208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The lateral thoracic area is a known source for perforator flaps for partial breast reconstruction. In this paper, we report our experience in designing and harvesting lateral thoracic perforator flaps for partial and total breast reconstruction with the introduction of the "propuller" concept. PATIENTS AND METHODS Between September 2013 and August 2021, 95 flaps were performed for immediate, partial and total breast reconstruction. On a total of 95 flaps, 30 (19 thoracodorsal artery perforator(TDAP) flaps, 10 lateral intercostal artery perforator(LICAP) flaps and 1 lateral thoracic artery perforator(LTAP) flap) were harvested in the traditional fashion (control group) and 65 (57 LICAP, 2 LTAP and 6 TDAP flaps) according to the propeller concept (study group). All cases were preoperatively planned with Color-Coded Duplex Ultrasound. RESULTS No flap losses were experienced in both groups. The mean operative time was 156 minutes (range 118-234) for the control group and 75 minutes (range 53-125) for the study group (p < 0.0001). A significantly higher number of LICAP flaps were chosen in the study group compared to control group. None of the patients had donor site complications. Patients' and Surgeons' satisfaction was high to very high. CONCLUSION The ultrasound preoperative planning led to the development of an easier and safer method of local perforator flap harvesting, that we named as propuller design. Its novelty lies in that perforator intraoperative selection and fully skeletonization are not needed and a more efficient flap movement (propeller plus advancement) which transfers more tissue into the new breast can be achieved safely, faster and easier.
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Affiliation(s)
- Giuseppe Visconti
- Dipartimento Salute della Donna, Bambino e Sanità Pubblica, UO Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore University Hospital A. Gemelli, Largo Agostino Gemelli, 8, 00168, Roma, Italy.
| | - Alessandro Bianchi
- Dipartimento Salute della Donna, Bambino e Sanità Pubblica, UO Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore University Hospital A. Gemelli, Largo Agostino Gemelli, 8, 00168, Roma, Italy
| | - Alba Di Leone
- Dipartimento Salute della Donna, Bambino e Sanità Pubblica, UO Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore University Hospital A. Gemelli, Largo Agostino Gemelli, 8, 00168, Roma, Italy
- Dipartimento Salute Della Donna, Bambino e Sanità Pubblica, UOC Chirurgia Senologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Gianluca Franceschini
- Dipartimento Salute Della Donna, Bambino e Sanità Pubblica, UOC Chirurgia Senologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Riccardo Masetti
- Dipartimento Salute Della Donna, Bambino e Sanità Pubblica, UOC Chirurgia Senologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marzia Salgarello
- Dipartimento Salute della Donna, Bambino e Sanità Pubblica, UO Chirurgia Plastica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore University Hospital A. Gemelli, Largo Agostino Gemelli, 8, 00168, Roma, Italy
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Maier MA, Hoffman RD, Kordahi AM, Levine J, St Hilaire H, Allen RJ. Surgical Delay of Thoracodorsal Artery Perforator Flaps for Total Autologous Breast Reconstruction. Ann Plast Surg 2024; 92:161-168. [PMID: 38198626 DOI: 10.1097/sap.0000000000003734] [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: 01/12/2024]
Abstract
BACKGROUND When abdomen-based free flap reconstruction is contraindicated, the muscle-sparing thoracodorsal artery perforator (TDAP) flap may be considered for total autologous breast reconstruction. The TDAP flap is often limited by volume and is prone to distal flap necrosis. We aim to demonstrate our experience combining the delay phenomenon with TDAP flaps for total autologous breast reconstruction. METHODS Patients presenting for autologous breast reconstruction between April 2021 and August 2023 were recruited for surgically delayed TDAP flap reconstruction when abdominally based free flap reconstruction was contraindicated because of previous abdominal surgery or poor perforator anatomy. We dissected the TDAP flap except for a distal skin bridge and then reconstructed the breast 1 to 7 days later. Data included flap dimensions (in centimeters × centimeters), delay time (in days), predelay and postdelay perforator caliber (in millimeters) and flow (in centimeters per second), operative time (in minutes), hospital length of stay (in days), complications/revisions, and follow-up time (in days). RESULTS Fourteen patients and 16 flaps were included in this study. Mean age and body mass index of patients were 55.9 ± 9.6 years and 30.1 ± 4.3 kg/m2, respectively. Average flap skin island length and width were 32.1 ± 3.3 cm (n = 8 flaps) and 8.8 ± 0.7 cm (n = 5 flaps), respectively. Beveled flap width reached 16.0 ± 2.2 cm (n = 3 flaps). Average time between surgical delay and reconstruction was 2.9 days, ranging from 1 to 7 days (n = 18 flaps). Mean predelay and postdelay TDAP vessel caliber and flow measured by Doppler ultrasound increased from 1.4 ± 0.3 to 1.8 ± 0.3 mm (P = 0.03) and 13.3 ± 5.2 to 43.4 ± 18.8 cm/s (P = 0.03), respectively (n = 4 flaps). Complications included 1 donor site seroma and 1 mastectomy skin flap necrosis. Follow-up ranged from 4 to 476 days (n = 17 operations). CONCLUSIONS We demonstrate surgically delayed TDAP flaps as a viable option for total autologous breast reconstruction. Our series of flaps demonstrated increased perforator caliber and flow and enlarged volume capabilities and had no incidences of flap necrosis.
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Affiliation(s)
| | | | - Anthony M Kordahi
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | | | - Hugo St Hilaire
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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Löfstrand J, Paganini A, Grimby-Ekman A, Lidén M, Hansson E. Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study. Br J Surg 2024; 111:znad296. [PMID: 37879120 PMCID: PMC10769156 DOI: 10.1093/bjs/znad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/06/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome. METHOD This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS). RESULTS A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction. CONCLUSION Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.
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Affiliation(s)
- Jonas Löfstrand
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Paganini
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Grimby-Ekman
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma Hansson
- Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Schwartz JCD. Surgical Delay of Thoracodorsal Artery Perforator Flaps for Bilateral Autologous Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5514. [PMID: 38204874 PMCID: PMC10781116 DOI: 10.1097/gox.0000000000005514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
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Khayat S, Bonsfills N, Antúnez-Conde R, Álvarez-Mokthari S, Aranibar H, Tousidonis M, Fernández-Fernández M, Díez-Montiel A. Parascapular Flap for Severe Hidradenitis Suppurativa. Case Rep Dermatol 2024; 16:8-16. [PMID: 38188892 PMCID: PMC10769502 DOI: 10.1159/000533387] [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: 04/25/2023] [Accepted: 07/27/2023] [Indexed: 01/09/2024] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory disease which affects apocrine glands and hair follicles of the skin, primarily in the axillary and groin regions. This condition can be highly debilitating, causing painful lesions and a negative psychological impact on patients. While medical and minimally invasive treatments are available, surgical intervention may be necessary for severe cases. In cases involving axillary defects, the use of local flaps such as the parascapular flap is a viable option. In this case report, we present a 34-year-old woman who presented to our clinic with a history of recurrent abscesses and cutaneous infections in the axillary region. After thorough evaluation, we chose to use the parascapular flap for reconstruction. The parascapular flap is a one-stage procedure that allows for extensive resection of the axillary area without resulting in contractions or retractions over the long term. Additionally, this technique allows for preservation of the axilla's original shape with minimal donor site morbidity.
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Affiliation(s)
- Saad Khayat
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Nuria Bonsfills
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | | | - Sara Álvarez-Mokthari
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Hubert Aranibar
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Tousidonis
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
| | - Mario Fernández-Fernández
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
- Department of Otorhinolaryngology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alberto Díez-Montiel
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- ICIRE Instituto de Cirugía Reconstructiva y Estética, Madrid, Spain
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Gunnarsson GL, Lilja C, Thomsen JB. Breast reconstruction with donor tissue from the back-an evolution towards customized reconstructive solutions guided by innovative surgery and patient wishes. Gland Surg 2023; 12:1137-1140. [PMID: 37842540 PMCID: PMC10570979 DOI: 10.21037/gs-23-325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 10/17/2023]
Affiliation(s)
| | - Caroline Lilja
- Research Unit of Plastic Surgery, Department of Plastic Surgery, Odense University Hospital & Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Jørn Bo Thomsen
- Research Unit of Plastic Surgery, Department of Plastic Surgery, Odense University Hospital & Clinical Institute, University of Southern Denmark, Odense, Denmark
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Anterior-First Approach for Latissimus Dorsi Myocutaneous Flap Breast Reconstruction: A Refined Elevation Method with Detailed Video Instructions. J Clin Med 2022; 11:jcm11247387. [PMID: 36556005 PMCID: PMC9781814 DOI: 10.3390/jcm11247387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The latissimus dorsi myocutaneous (LDMC) flap is a preferred flap in breast reconstruction for its wide surface area and volume. Since the flap is situated in the midback area, a lateral decubitus approach is a conventional method. However, proper visualization and access to the thoracodorsal vascular pedicle or muscle insertion is difficult from the lateral approach, causing inefficiency and surgeon fatigue. We propose the ‘anterior-first’ approach in LDMC flap reconstruction, where the landmark structures are first approached from the supine-anterior position through the mastectomy incision. Methods: From January 2014 to December 2020, 48 patients who received immediate breast reconstruction with LDMC flap were included in the study. Patients received reconstruction with the conventional approach (n = 20), or anterior-first approach (n = 28). Demographic factors and the operative outcomes were retrospectively analyzed and compared between the two groups. Results: Compared to the conventional approach group, the anterior-first approach group showed improved efficiency in the duration of total reconstruction (228 versus 330 min, p < 0.001), and flap elevation (139 versus 200 min, p < 0.001). No difference in complication rate and time to drain removal was observed (p = 0.14 and >0.9, respectively). Conclusion: The anterior-first approach for breast reconstruction with LDMC flap provides surgeons with an enhanced surgical exposure and superior ergonomics, leading to a safer and more efficient flap elevation.
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Ponomarenko OV, Serhieieva LN, Parkhomenko KY. Surgical treatment results in patients with defects of the integumentary tissues of the trunk and limbs of mechanical origin. J Med Life 2022; 15:1358-1364. [PMID: 36567839 PMCID: PMC9762375 DOI: 10.25122/jml-2022-0019] [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: 01/20/2022] [Accepted: 09/13/2022] [Indexed: 01/03/2023] Open
Abstract
This study aimed to develop and implement a universal method for the quantitative assessment of treatment effectiveness in patients with skin and underlying soft tissue defects of the trunk and extremities. The study involved 242 patients, including 46 patients with upper extremity injuries, 179 with lesions of lower extremity tissues, and 17 patients with defects of the integumentary tissues of the trunk. The greatest treatment effectiveness was observed in patients with upper limb injury: excellent result - 60.0%, good - 33.3%, unsatisfactory - 6.7% of patients. In the group of patients with lower extremity injuries, an excellent result was recorded in 19.6% of cases, good (58.1%), satisfactory (15.1%), and unsatisfactory in 7.2% of patients. In patients with trunk injuries, an excellent treatment result was obtained in 23.5%, good - 35.5%, satisfactory - 23.5%, and unsatisfactory - 17.6%. The universal quantitative method for evaluating treatment effectiveness in patients with various types of damage to the trunk and extremities tissues was proposed. This method makes it possible to objectively determine the level of medical service provided to each patient, which is of great importance in the context of medical service reorganization in the state.
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Affiliation(s)
- Olena Vasylivna Ponomarenko
- Department of Medicine of Catastrophes, Military Medicine and Neurosurgery, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine,Corresponding Author: Olena Vasylivna Ponomarenko, Department of Medicine of Catastrophes, Military Medicine and Neurosurgery, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine E-mail:
| | - Ludmila Nylsivna Serhieieva
- Department of Medical Physics, Biophysics and Higher Mathematics, Zaporizhzhia State Medical University, Zaporizhzhia, Ukraine
| | - Kyrylo Yuriiovych Parkhomenko
- Department of General Practice Family Medicine and Internal Medicine, Kharkiv National Medical University, Kharkiv, Ukraine
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Gal S, Movassaghi K. Optimizing Aesthetics in Reconstructive Breast Surgery Using Muscle-Sparing Latissimus Dorsi Flap in Radiated and Nonradiated Patients. Ann Plast Surg 2022; 88:381-388. [PMID: 35312648 DOI: 10.1097/sap.0000000000003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The latissimus dorsi musculocutaneous flap (LDMF) has been a workhorse for breast reconstruction. Its high rate of donor-site morbidity has led to the advent of the muscle-sparing latissimus dorsi flap (MSLDF). However, there are very limited reports using the MSLDF in irradiated patients. Prior studies of MSLDF have either precluded previously radiated patients from receiving MSLDF or have included them as part of their larger MSLSDF cohort without specifically analyzing their outcome as a separate group or comparing them to the traditional LDMF group. OBJECTIVE We describe the technique and outcome of MSLDF in both radiated and nonradiated patients and compare the outcome to our LDMF patients. METHODS A retrospective chart review of patients undergoing breast reconstruction between 2003 and 2020 using either a pedicled MSLDF or LDMF with a transverse skin paddle was conducted. All patients underwent a 2-stage reconstruction with the flap and tissue expander placement done during the first stage, and replacement with implant and, if needed, fat grafting to enhance soft tissue during the second stage. Complications, subjective functional morbidity, and aesthetic outcomes were reviewed. RESULTS A total of 35 MSLDFs and 40 LDMFs were performed: 24 MSLDFs (69%) and 25 LDMFs (63%) were inset into a previously irradiated field. There were 2 cases of infection requiring explantation in both MSLDF (8.3%) and LDMF (8.0%) radiated cohorts. There were no cases of donor-site seroma in the MSLDF cohorts versus 12 (30%) in the LDMF cohorts. Minor distal tip superficial epidermolysis was seen in 5 MSLDFs (14.3%), 3 of which were in the radiated cohort, and in 1 LDMF (2.5%) radiated cohort with no cases of flap loss. Functional and aesthetic outcomes were satisfactory. Four patients who had a unilateral MSLDF had a completion upper back lift. CONCLUSIONS This is the largest series to date demonstrating the use of the MSLDF in both nonradiated and radiated patients and comparing it to a standard LDMF for breast reconstruction by the same surgeon. The pedicled MSLDF is a versatile option for breast reconstruction in radiated patients, and radiation should not be considered a contraindication for its use.
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Ete G, Paul K, Akamanchi AK, Cordelia M J F, Agarwal S. Pedicled thoracodorsal artery perforator flap in the soft-tissue reconstruction of an acute traumatic cubital fossa defect. J Plast Reconstr Aesthet Surg 2022; 75:2070-2076. [PMID: 35365410 DOI: 10.1016/j.bjps.2022.02.028] [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: 06/04/2021] [Revised: 01/12/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Complex cubital fossa injuries with bony and vascular injuries are not an uncommon clinical presentation after trauma to the elbow. The revascularization of the upper limb by brachial artery repair with the venous graft is paramount, followed by immediate cover with a sturdy flap to salvage the limb. The use of local muscle and fasciocutaneous flaps is limited in the setting of vascular injury. The pedicled latissimus dorsi muscle flap and abdominal flaps are routinely used with few advantages. This article describes the use of a pedicled thoracodorsal artery perforator flap in the management of acute traumatic cubital fossa defect. MATERIAL AND METHODS A retrospective observational study was performed from September 2015 to December 2020 with patients who underwent the pedicled TDAP flap as a soft-tissue cover of cubital fossa injuries primarily. Patient variables, including the size of defect and flap, the number of perforators, the complications, and the outcome, were recorded. RESULTS Eleven patients were included in the study. The majority of the patients were males (n = 10) and presented with a history of trauma in a road traffic accident (n = 6) or because of a fall from height (n = 4). All of them (n = 11) had some form of bony injury. Seven patients in this group required brachial artery repair with an interposition vein graft successfully covered with a TDAP flap. There was a constant dominant musculocutaneous perforator about 10-13 cm from the apex of the axilla. At discharge, all flaps had settled well. On follow-up ranging from 2 months to 2 years, the patients reported satisfactory outcomes.
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Affiliation(s)
- Geley Ete
- Department of Plastic Surgery, Christian Medical College, Vellore, India
| | - Kingsly Paul
- Department of Plastic Surgery, Christian Medical College, Vellore, India
| | | | - Felix Cordelia M J
- Department of Plastic Surgery, Christian Medical College, Vellore, India
| | - Shwetha Agarwal
- Department of Plastic Surgery, Christian Medical College, Vellore, India.
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