Vascular pedicle avulsion in free flap breast reconstruction: A case of diep flap salvage following early avulsion of venous anastomosis and literature review

Microsurgery ◽  
2010 ◽  
Vol 30 (3) ◽  
pp. 233-237 ◽  
Author(s):  
Efstathios G. Lykoudis ◽  
Dimosthenis E. Ziogas ◽  
George E. Papanikolaou
Keyword(s):  
Literature Review ◽  
Breast Reconstruction ◽  
Free Flap ◽  
Diep Flap ◽  
Vascular Pedicle ◽  
Venous Anastomosis

Changes to Venous Flow Coupler Signal during DIEP Flap Inset Can Be Predictive of Poor Clinical Outcomes in Autologous Breast Reconstruction

2020 ◽  
Vol 36 (06) ◽  
pp. 466-470 ◽  
Author(s):  
Salih Colakoglu ◽  
Ariel Johnson ◽  
Jaclyn Anderson ◽  
David Woodbridge Mathes ◽  
Tae Woon Chong
Keyword(s):  
Breast Reconstruction ◽  
Clinical Outcomes ◽  
Free Flap ◽  
Free Flaps ◽  
Patient Characteristics ◽  
Diep Flap ◽  
Signal Loss ◽  
Venous Anastomosis ◽  
Venous Flow ◽  
Venous Signal

Abstract Background Venous flow couplers are typically used to monitor free flaps during the postoperative period, with a continuous venous signal available immediately after completion of the anastomosis. Intraoperative loss of the coupler signal is not uncommon and may require adjustments in free flap inset and even flap thickness to get the venous signal to return. The effects of intraoperative coupler signal loss and the role of this technology on flap outcomes have not been evaluated. We hypothesized that the use of intraoperative coupler can be protective of both early and late flap complications by preventing unfavorable flap insets. Patients and Methods All patients who underwent free flap breast reconstruction between January 2018 and June 2019 by single microsurgery team were included. Flap inset and inset changes based on flow coupler signal problems were reviewed in the procedure notes. Patient demographics data and clinical outcomes were analyzed with comprehensive chart review. Results Forty-four consecutive patients with 69 free flaps were identified. There were no significant differences in patient characteristics or venous coupler size used in venous anastomosis. Although the number of operating room take backs for venous insufficiency was not significantly different between two groups, the free flaps with inset change had significantly higher complications that required later surgical intervention (p = 0.0464). Conclusion Surgeons should be aware that intraoperative coupler signal loss can be associated with poor clinical outcomes postoperatively and these flaps may require more perfusion imaging, flap debulking, or even additional venous anastomosis.

scholarly journals Refractory Donor-Site Seroma Following DIEP Breast Reconstruction

2020 ◽  
Vol 6 ◽  
pp. 2513826X1989883
Author(s):  
Trina V. Stephens ◽  
Nancy Van Laeken ◽  
Sheina A. Macadam
Keyword(s):  
Literature Review ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Diep Flap ◽  
First Line ◽  
Percutaneous Aspiration ◽  
Autologous Breast Reconstruction ◽  
History Of ◽  
Deep Inferior Epigastric Perforator ◽  
Latissimus Dorsi Flaps

Donor-site seroma formation is a complication of autologous breast reconstruction reported most commonly with the use of latissimus dorsi flaps. First-line treatment is percutaneous aspiration which leads to resolution in the majority of cases. Those that persist may progress to a chronic, refractory seroma, which can prove challenging in terms of treatment. The aim of this article is to provide an updated literature review of interventions for chronic donor-site seroma and present the case of a 65-year-old female with a recalcitrant abdominal seroma following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Literature review revealed a single article that reported 2 cases of persistent donor-site seroma after DIEP flap breast reconstruction. The patient presented here underwent repeat aspiration, drain placement, and multiple surgical procedures to achieve resolution. In total, the post-reconstruction seroma history of the patient extended over approximately 14 months. We conclude with evidence-based suggestions for chronic, donor-site seroma prevention and treatment.

EP.TH.286Optimisation of Secondary Breast Reconstruction

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Klemen Lovšin ◽  
Uroš Ahčan ◽  
Andrej Lapoša
Keyword(s):  
Patient Satisfaction ◽  
Breast Reconstruction ◽  
Free Flap ◽  
Intercostal Nerve ◽  
Diep Flap ◽  
Autologous Breast Reconstruction ◽  
Patient Satisfaction Score ◽  
Preliminary Results ◽  
Level Of Satisfaction ◽  
Reconstructed Breast

Abstract Aims The purpose of secondary breast reconstruction is to restore patient’s integrity. Autologous breast reconstruction has become the superior method of breast reconstruction, especially in cases with inadequate skin envelope and post-radiotherapy tissue damage. A 3D-template-enhanced secondary autologous breast reconstruction with restoration of innervation was developed at our department. Methods Thirty patients are planned to be included in the prospective double-blinded study. The reconstruction is performed with the deep inferior epigastric perforator (DIEP) free flap using 3D template from the contralateral healthy breast. Additionally, coaptation of the anterior branch of the 3rd intercostal nerve with the dominant lateral intercostal nerve innervating the DIEP flap is performed. Breast-Q questionnaires are collected before and after the reconstruction and the breast sensation is assessed on regular intervals. Results The preliminary results show an improvement in the sensation of the reconstructed breast and higher patient satisfaction score. Prior to abstract submission, no significant complications have been noted, in one patent abnormal sensation of the breast was reported. Conclusions According to previous studies, patients with innervated free flap reconstruction express higher level of satisfaction as the sensation of the reconstructed breast contributes significantly to the level of satisfaction. Furthermore, use of 3D model from the contralateral breast produces results that are superior to traditional methods. Preliminary results showed that the combination of both methods improved patient satisfaction regarding the aesthetic outcome and functional result. With the appropriate patient selection this type of optimised breast reconstruction should be performed.

scholarly journals Outcomes of Breast Free Flap Reconstruction in the Middle East

2021 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Quality Of Life ◽  
Middle East ◽  
Breast Reconstruction ◽  
Free Flap ◽  
Standard Of Care ◽  
Diep Flap ◽  
Nipple Reconstruction ◽  
Breast Cancer Patients ◽  
Satisfaction Rates

Objectives: Reviewing patient satisfaction and quality of life following post mastectomy breast reconstruction in breast cancer patients of Middle East. Methods: Retrospective study of 68 patients of post mastectomy who underwent free flap-based breast reconstruction with a mean follow up of 6 months were studied over a period of 5½ years. Specific preoperative investigation included CT angiography of the abdominal wall for perforator assessment. All of breasts were reconstructed by microsurgical free flap breast reconstruction. A questionnaire was developed for the postoperative patients in order to assess their satisfaction grades. Results: A total of 67 patients of post mastectomy females attended to our clinic for breast reconstruction. Most of the patients (97.3%) were in the age group of 29-53 years. Majority of patients (68%) underwent delayed reconstruction. Average BMI at reconstruction in most females was 30.1. CT angio demonstrated two ideal perforators in 59% of cases. Majority underwent reconstruction by free DIEP flap. Complications occurred in 6.4% of patients. Overall satisfaction rates of 92% was noted. At the completion of the study 30% has completed nipple reconstruction. Conclusion: With the availability of “state of the art” microsurgical breast reconstruction, in properly selected patients, the quality of life and satisfaction rates are high and free flap breast reconstruction has proven to be the standard of care in post mastectomy patient population.

Postoperative Monitoring of Free DIEP Flap in Breast Reconstruction with Near-Infrared Spectroscopy: Variables Affecting the Regional Oxygen Saturation

2018 ◽  
Vol 34 (06) ◽  
pp. 383-388 ◽  
Author(s):  
Marzia Salgarello ◽  
Domenico Pagliara ◽  
Marco Rossi ◽  
Giuseppe Visconti ◽  
Liliana Barone-Adesi
Keyword(s):  
Infrared Spectroscopy ◽  
Breast Reconstruction ◽  
Oxygen Saturation ◽  
Near Infrared Spectroscopy ◽  
Free Flap ◽  
Linear Correlation ◽  
Near Infrared ◽  
Skin Flap ◽  
Diep Flap ◽  
Negative Linear Correlation

Background The timing of surgical reexploration in microanastomotic thrombosis is directly related to the salvage rate of free flap. Near-infrared spectroscopy (NIRS) is a noninvasive technique, which allows a continuous bedside monitoring of flap oxygenation. The current literature is lacking in the assessment of variables able to modify the NIRS monitoring. The aim of this study is to identify patient and flap-related variables that can affect regional oxygen saturation (rSO2). Methods We retrospectively analyzed the data obtained from 45 consecutive patients undergoing breast reconstruction with deep inferior epigastric perforator (DIEP) flap. The monitoring device used is the Somanetics INVOS 5100C Cerebral/Somatic Oximeter (Covidien). Baseline measures of demographic–anthropometric variables (age, weight, height, body mass index [BMI]) and flap factors (flap size in grams, skin flap area in square centimeters, perforator number, and perforator size in millimeters) were collected from preoperative and intraoperative assessment. We investigated the linear correlation between mean rSO2 and BMI, flap size, skin flap area, perforator number, and perforator size. Results A positive linear correlation between rSO2 values and skin flap area, perforator number, and perforator size was found. A negative linear correlation between rSO2 values and BMI and flap size was found. All correlations are statistically significant. Despite the overall negative linear correlation between rSO2 values and flap size, we observed a bimodal trend: a positive relation up to 800 g, which is inverted above 800 g. Conclusion The NIRS is a reliable additional tool in free flap monitoring. A careful evaluation should be given to patients and surgery factors that can change the oximetry data.

scholarly journals Correlating the deep inferior epigastric artery branching pattern with type of abdominal free flap performed in a series of 145 breast reconstruction patients

2012 ◽  
Vol 94 (7) ◽  
pp. 493-495 ◽  
Author(s):  
AR Molina ◽  
ME Jones ◽  
A Hazari ◽  
I Francis ◽  
C Nduka
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Diep Flap ◽  
Branching Pattern ◽  
Inferior Epigastric Artery ◽  
Flap Loss ◽  
Epigastric Artery ◽  
Lateral Muscle ◽  
Deep Inferior Epigastric Artery

INTRODUCTION The deep inferior epigastric perforator (DIEP) flap is currently viewed as the gold standard in autologous breast reconstruction. We studied three-dimensional computed tomography angiography (CTA) in 145 patients undergoing free abdominal flap breast reconstruction to try to correlate deep inferior epigastric artery (DIEA) branching pattern with the type of flap performed and patient outcome. Today, reconstructive breast surgeons have become more experienced in raising DIEP flaps and operative times are becoming more acceptable. However, there remains significant interest in finding ways to aid this challenging dissection. METHODS We retrospectively evaluated consecutive patients between January 2007 and August 2008. CTAs were analysed using the Moon and Taylor (1988) classification of the DIEA branching pattern. Data gathered included pre-operative morbidity, type of abdominal wall free flap performed, length of operation, length of stay and complications. RESULTS Some 150 breast reconstructions were performed in 145 patients. There were 67 DIEP flaps, 69 MS-2 transverse rectus abdominis myocutaneous (TRAM) flaps and 14 MS-1 TRAM flaps (where MS-1 spares the lateral muscle and MS-2 spares both lateral and medial segments). Proportionally more DIEP flaps were performed in patients with a type 2 branching pattern. There was one flap loss (0.67%). CONCLUSIONS In this large CTA series, we found a type 1 (single artery) DIEA pattern most frequently, in contrast to the predominance of the type 2 bifurcating pattern observed previously. The higher proportion of DIEP flaps performed in the type 2 pattern patients is consistent with the documented shorter intramuscular course in this group. We have found CTA useful for faster selection of the best hemiabdomen for dissection and flap loss rates in our unit have reduced from 1.5% to 0.67%.

scholarly journals Different Hydraulic Constructs to Optimize the Venous Drainage of DIEP Flaps in Breast Reconstruction: Decisional Algorithm and Review of the Literature

2020 ◽  
Author(s):  
Marco Pignatti ◽  
Valentina Pinto ◽  
Federico A. Giorgini ◽  
Maria Elisa Lozano Miralles ◽  
Salvatore D'Arpa ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Preventive Measure ◽  
Venous Drainage ◽  
Venous Congestion ◽  
Cochrane Library ◽  
Diep Flap ◽  
Related Complication ◽  
Venous Anastomosis ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery

Abstract Background Venous congestion is the most common perfusion-related complication of deep inferior epigastric artery perforator (DIEP) flap. Several hydraulic constructs can be created for venous superdrainage in case of flap venous engorgement or as a preventive measure. These can be classified based on the choice of the draining vein of the flap, either a second deep inferior epigastric vein (DIEV) or a superficial inferior epigastric vein (SIEV), and of the recipient vein, either a vein of the chest or the DIEV. Methods We conducted a comprehensive systematic literature review in Medline, Scopus, EMBASE, Cochrane Library, and Google Scholar to find publications that reported on venous congestion in DIEP flap. The keywords used were DIEP Flap, breast reconstruction, venous congestion, supercharging, superdrainage, SIEV, and DIEV. Results Based on the studies found in the literature, we developed an algorithm to guide the surgeon's decision when choosing the veins for the superdrainage anastomosis. Conclusion Several alternatives for venous anastomosis in superdrainage are available. We propose an algorithm to simplify the choice. The use of the ipsilateral SIEV to be connected to a vein of the chest appears to be advantageous. The anatomical position that allows the easiest anastomosis dictates which chest vein to favor.

Immediate Breast Reconstruction with Stacked Diep Flap

2014 ◽  
Vol 30 (S 01) ◽  
Author(s):  
Carmen Suñé ◽  
David Carrillo ◽  
Cristian Lopez ◽  
Marco Serena Signes ◽  
Alejandra Sainz ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Immediate Breast Reconstruction ◽  
Diep Flap
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