Safety and donor site morbidity of the transverse musculocutaneous gracilis (TMG) flap in autologous breast reconstruction—A systematic review and meta‐analysis

Background The transverse upper gracilis (TUG) flap has gained increasing acceptance as a reliable option for breast reconstruction, specifically in patients without adequate abdominal tissue. Three major flap designs of the upper gracilis flap have been proposed to balance volume needs with flap vascularity. A systematic review was performed to identify outcomes of the major gracilis flaps: TUG, vertical-transverse upper gracilis (V-TUG), and longitudinal gracilis myocutaneous (LGM) flaps. This study is the first and only systematic review to date reviewing the variations of the upper gracilis flap in microsurgical breast reconstruction. Methods A systematic review of the literature was conducted using PubMed database from 1966 through 2015. Inclusion and exclusion criteria were applied. Outcomes assessed included total flap volumes, additional breast procedures to achieve intended breast volume, and complication rates. Results A total of 485 gracilis-type flaps were performed in 335 patients. V-TUG flaps provided the largest mean flap weights and did not require additional lipofilling or implant placement, whereas the majority of TUG flaps (50.6%) required additional fat grafting or implant placements. All flap types demonstrated a low incidence of donor-site morbidity. Overall flap loss rate was low; TUG flaps reported 2.3% total and 2.0% partial flap losses, while V-TUG and LGM flaps reported no flap losses. Conclusion This review found V-TUG yielded highest mean flap weights and did not require additional breast augmentation procedures as compared with the TUG. Also, the V-TUG was a safer donor-site option with fewer flap and donor-site morbidities.

Download Full-text

Effects of pre-existing abdominal scar on postoperative complications after autologous breast reconstruction using abdominal flaps: A systematic review and meta-analysis

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.11.020 ◽

2020 ◽

Author(s):

Jae-Ho Chung ◽

Sung-Min Sohn ◽

Seung-Pil Jung ◽

Seung-Ha Park ◽

Eul-Sik Yoon

Keyword(s):

Systematic Review ◽

Postoperative Complications ◽

Breast Reconstruction ◽

Meta Analysis ◽

Autologous Breast Reconstruction ◽

Abdominal Scar ◽

Abdominal Flaps

Download Full-text

Comparing the thoracodorsal and internal mammary vessels as recipients for microsurgical autologous breast reconstruction: A systematic review and meta‐analysis

Microsurgery ◽

10.1002/micr.30244 ◽

2017 ◽

Vol 37 (8) ◽

pp. 937-946 ◽

Cited By ~ 4

Author(s):

Osama A. Samargandi ◽

Jessica Winter ◽

Joseph P. Corkum ◽

Sarah Al Youha ◽

Simon G. Frank ◽

...

Keyword(s):

Systematic Review ◽

Breast Reconstruction ◽

Meta Analysis ◽

Autologous Breast Reconstruction ◽

Internal Mammary ◽

Internal Mammary Vessels

Download Full-text

Donor-site morbidity after osteochondral autologous transplantation for osteochondritis dissecans of the capitellum: a systematic review and meta-analysis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-017-4516-8 ◽

2017 ◽

Vol 25 (7) ◽

pp. 2237-2246 ◽

Cited By ~ 32

Author(s):

Rens Bexkens ◽

Paul T. Ogink ◽

Job N. Doornberg ◽

Gino M. M. J. Kerkhoffs ◽

Denise Eygendaal ◽

...

Keyword(s):

Systematic Review ◽

Osteochondritis Dissecans ◽

Meta Analysis ◽

Donor Site ◽

Autologous Transplantation ◽

Donor Site Morbidity ◽

Osteochondral Autologous Transplantation

Download Full-text

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

Breast Cancer ◽

10.1007/s12282-021-01264-7 ◽

2021 ◽

Author(s):

Laura C. Siegwart ◽

Sebastian Fischer ◽

Yannick F. Diehm ◽

Jörg M. Heil ◽

Christoph Hirche ◽

...

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Wound Dehiscence ◽

Donor Site Morbidity ◽

Normal Weight ◽

Autologous Breast Reconstruction ◽

Medial Thigh ◽

The Mean ◽

Breast Shape ◽

Surgical Site Complications

Abstract Purpose The transverse musculocutaneous gracilis (TMG) flap is as a valuable alternative in autologous breast reconstruction. The purpose of this study was to evaluate the donor site morbidity and secondary refinement procedures after TMG flap breast reconstruction. Methods A retrospective study was conducted, including all patients who received TMG flap breast reconstructions, from January 2012 to August 2019. Primary outcomes were surgical site complications of the donor site and secondary refinement procedures carried out for aesthetic or reconstructive purposes for the medial thigh. Secondary outcomes of interest were lipofilling procedures for optimization of the reconstructed breasts. Results Ninety-nine patients received 159 TMG flaps for breast reconstruction. Patients’ mean BMI was 23.5 (15.6–32.5) kg/m2. Bilateral breast reconstructions were performed in 60.6%. The mean flap volume was 330 (231–440) g. Surgical site complications occurred in 14.5% of the TMG donor sites and wound dehiscence was the most common complication (9.4%). Lymphedema occurred in 1.8% of the donor thighs. Aesthetic refinement procedures were performed in 25.2% on the donor thigh or contralateral thigh. Secondary lipofilling was performed in 54.1% of the reconstructed breasts and fat was harvested in only 11.9% from the legs. Conclusion The TMG flap breast reconstruction combines low donor site morbidity with adequate volume for appealing breast results, particularly in slim-to-normal weight patients. However, patients should be informed about the likelihood of secondary refinement procedures on the donor site and the need of lipofilling to optimize the breast shape and volume.

Download Full-text

Transversus Abdominis Plane Blocks in Microsurgical Breast Reconstruction: A Systematic Review and Meta-analysis

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1701663 ◽

2020 ◽

Vol 36 (05) ◽

pp. 353-361

Author(s):

Salma A. Abdou ◽

David A. Daar ◽

Stelios C. Wilson ◽

Vishal Thanik

Keyword(s):

Systematic Review ◽

Breast Reconstruction ◽

Meta Analysis ◽

Hospital Length ◽

Current Data ◽

Transversus Abdominis ◽

Hospital Length Of Stay ◽

Tap Block ◽

Transversus Abdominis Plane ◽

Autologous Breast Reconstruction

Abstract Background Transversus abdominis plane (TAP) blocks have been shown to significantly reduce pain and narcotic consumption following major abdominal surgeries. This study investigates the literature on their use in microsurgical breast reconstruction. Patients and Methods A systematic review of TAP blocks in autologous breast reconstruction was performed. Results Across 10 included studies, 174 patients (5 studies) received an intraoperative TAP block injection, 185 patients (4 studies) received a TAP catheter for intermittent postoperative analgesia, and 325 patients served as controls for a total of 684 included patients. The majority of TAP block delivery techniques were ultrasound guided (7/10 studies). Liposomal bupivacaine (LB) was the most commonly used analgesic (4 studies and139 patients) followed by conventional bupivacaine (3 studies and 105 patients). Eight studies found a significant reduction in oral, intravenous, and/or total morphine requirements in the TAP group when either the daily average and/or total inpatient consumption was compared with the control. Hospital length of stay was significantly shorter for patients undergoing single intraoperative TAP block injection with any analgesic as compared with standard narcotic-based protocols (mean difference= −0.95 days; 95% CI: −1.72 to −0.17 days; p = 0.02). Looking at TAP blocks specifically with LB, there was a mean decrease of 0.83 days as compared with the control, which was not statistically significant (95% CI: −1.90 to 0.25 days; p = 0.13). Conclusion While the current data support the use of TAP blocks in autologous breast reconstruction, additional studies with more standardized protocols should be performed to determine the most optimal practice.

Download Full-text