scholarly journals Necrosis or Flap Loss After Deep Inferior Epigastric Perforator Reconstruction: Impact of Perforators and Recipient Vessels

2021 ◽  
Vol 06 (01) ◽  
pp. e20-e27
Author(s):  
Johanna S. Palve ◽  
Tiina H. Luukkaala ◽  
Minna T. Kääriäinen
Keyword(s):  
Loss Rate ◽  
Diep Flap ◽  
Flap Necrosis ◽  
Flap Survival ◽  
Flap Loss ◽  
Internal Mammary ◽  
Deep Inferior Epigastric Perforator ◽  
Internal Mammary Vessels ◽  
Intraoperative Conversion ◽  
The Impact

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.

scholarly journals Smoking and Flap Survival

2018 ◽  
Vol 26 (4) ◽  
pp. 280-285 ◽  
Author(s):  
Kun Hwang ◽  
Ji Soo Son ◽  
Woo Kyung Ryu
Keyword(s):  
Loss Rate ◽  
Fat Necrosis ◽  
Flap Surgery ◽  
Flap Survival ◽  
Flap Loss ◽  
Significant Difference ◽  
Before And After ◽  
Alveolar Oxygen ◽  
Abstinence Period ◽  
Wound Tissue

Purpose: The aim of this study was to compare the complications of flap surgery in non-smokers and smokers and to determine how the incidence of complications was affected by the abstinence period from smoking before and after flap surgery. Methods: In PubMed and Scopus, terms “smoking” and “flap survival” were used, which resulted in 113 papers and 65 papers, respectively. After excluding 6 duplicate titles, 172 titles were reviewed. Among them, 45 abstracts were excluded, 20 full papers were reviewed, and finally 15 papers were analyzed. Results: Post-operative complications such as flap necrosis ( P < .001), hematoma ( P < .001), and fat necrosis ( P = .003) occurred significantly more frequently in smokers than in non-smokers. The flap loss rate was significantly higher in smokers who were abstinent for 24 hours post-operatively than in non-smokers (n = 1464, odds ratio [OR] = 4.885, 95% confidence interval [CI] = 2.071-11.524, P < .001). The flap loss rate was significantly lower in smokers who were abstinent for 1 week post-operatively than in those who were abstinent for 24 hours post-operatively (n = 131, OR = 0.252, 95% CI = 0.074-0.851, P = .027). No significant difference in flap loss was found between non-smokers and smokers who were abstinent for 1 week preoperatively (n = 1519, OR = 1.229, 95% CI = 0.482-3.134, P = .666) or for 4 weeks preoperatively (n = 1576, OR = 1.902, 95% CI = 0.383-2.119, P = .812). Conclusion: Since smoking decreases the alveolar oxygen pressure and subcutaneous wound tissue oxygen, and nicotine causes vasoconstriction, smokers are more likely to experience flap loss, hematoma, or fat necrosis than non-smokers. Preoperative and post-operative abstinence period of at least 1 week is necessary for smokers who undergo flap operations.

Bilateral DIEP Flap Breast Reconstruction to a Single Set of Internal Mammary Vessels

2019 ◽  
Vol 144 (4) ◽  
pp. 554e-564e
Author(s):  
Dries Opsomer ◽  
Salvatore D’Arpa ◽  
Lara Benmeridja ◽  
Filip Stillaert ◽  
Warren Noel ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Diep Flap ◽  
Internal Mammary ◽  
Internal Mammary Vessels ◽  
Single Set

scholarly journals Investigating the Impact of Flap Overdesign on Viability

2016 ◽  
Vol 02 (02) ◽  
pp. e37-e41
Author(s):  
Andrew Aherrera ◽  
David Pincus ◽  
Adam Vernadakis
Keyword(s):  
Rat Model ◽  
Random Pattern ◽  
Width Ratio ◽  
Flap Necrosis ◽  
Sprague Dawley ◽  
Flap Survival ◽  
Sprague Dawley Rats ◽  
Varying Length ◽  
The Mean ◽  
The Impact

Background Partial or complete flap necrosis is a detrimental outcome complicating reconstructive surgery. The purpose of this study was to evaluate the impact of flap overdesign on viability in the rat model. Methods Forty Sprague-Dawley rats were equally divided into four groups receiving flaps of varying length-to-width ratios: 2:1, 3:1, 4:1, and 5:1. All animals had caudally based, modified McFarlane-style flap created. Areas of survival were assessed 14 days postoperatively and compared among groups using one-way analysis of variance. Results The mean areas of flap survival were 8.0 ± 0.0 cm2, 7.8 ± 1.1 cm2, 8.3 ± 1.1 cm2, and 8.1 ± 1.5 cm2 for the 2:1, 3:1, 4:1, and 5:1 length-to-width ratio groups, respectively. There were no statistically significant differences in mean areas of flap survival among groups (p > 0.05). Conclusion Flap overdesign does not increase the risk of flap necrosis in a random-pattern flap.

The Retrograde Limb of Internal Mammary Vessels as Reliable Recipient Vessels in DIEP Flap Breast Reconstruction

2015 ◽  
Vol 74 (4) ◽  
pp. 447-453 ◽  
Author(s):  
Marzia Salgarello ◽  
Giuseppe Visconti ◽  
Liliana Barone-Adesi ◽  
Alessandro Cina
Keyword(s):  
Breast Reconstruction ◽  
Diep Flap ◽  
Internal Mammary ◽  
Internal Mammary Vessels

scholarly journals Effects of venous supercharging in deep inferior epigastric artery perforator flap

2007 ◽  
Vol 22 (6) ◽  
pp. 474-478 ◽  
Author(s):  
Anne Karoline Groth ◽  
Antônio Carlos Ligocki Campos ◽  
Carolina Gomes Gonçalves ◽  
Ruy Fernando Caetano da Silva ◽  
Alfredo Benjamim Duarte da Silva ◽  
...  
Keyword(s):  
Perforator Flap ◽  
Control Group ◽  
Diep Flap ◽  
Inferior Epigastric Artery ◽  
Doppler Flowmetry ◽  
Flap Survival ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Deep Inferior Epigastric Perforator ◽  
Artery Perforator

PURPOSE: To evaluate the effects of venous supercharging in deep inferior epigastric artery perforator flap in rats. METHODS: 20 Wistar rats were randomized in 2 groups: control group (C), all had flaps raised based on the deep inferior epigastric perforator vessels (DIEP), and experimental group (E), which was identical to group C, except that the contralateral superficial inferior epigastric vein was also kept with the flap. Flow studies using laser Doppler flowmetry where performed daily in the four zones of the flap. On the 7th postoperative day rats were killed and flap survival was determined using digital planimetry. RESULTS: Flow values were presented as a percentage of the baseline flow after incision of the flap edges. The surviving flap area was demonstrated as a percentage of the total flap area. Evaluation by digital planimetry showed that flap survival in group E was higher than in group C (97,38%±1,32%vs.44,13%±4,83%, p=0,0006). CONCLUSION: This study shows that venous supercharging of the rat DIEP flap results in greater flap survival.

scholarly journals Comparison of the second and third intercostal spaces regarding the use of internal mammary vessels as recipient vessels in DIEP flap breast reconstruction: An anatomical and clinical study

2020 ◽  
Vol 47 (4) ◽  
pp. 333-339
Author(s):  
Ik Hyun Seong ◽  
Kyong-Je Woo
Keyword(s):  
Breast Reconstruction ◽  
Vessel Diameter ◽  
Diep Flap ◽  
Inferior Epigastric Artery ◽  
The Third ◽  
Epigastric Artery ◽  
Internal Mammary ◽  
Sternal Border ◽  
Deep Inferior Epigastric Artery ◽  
Internal Mammary Vessels

Background The purpose of this study was to compare the anatomical features of the internal mammary vessels (IMVs) at the second and third intercostal spaces (ICSs) with regard to their use as recipient vessels in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.Methods A total of 38 consecutive DIEP breast reconstructions in 36 patients were performed using IMVs as recipient vessels between March 2017 and August 2018. The intraoperative findings and postoperative complications were analyzed. Anatomical analyses were performed using intraoperative measurements and computed tomography (CT) angiographic images.Results CT angiographic analysis revealed the mean diameter of the deep inferior epigastric artery to be 2.42±0.27 mm, while that of the deep inferior epigastric vein was 2.91±0.30 mm. A larger mean vessel diameter was observed at the second than at the third ICS for both the internal mammary artery (2.26±0.32 mm vs. 1.99±0.33 mm, respectively; P=0.001) and the internal mammary vein (IMv) (2.52±0.46 mm vs. 2.05±0.42 mm, respectively; P<0.001). Similarly, the second ICS was wider than the third (18.08±3.72 mm vs. 12.32±2.96 mm, respectively; P<0.001) and the distance from the medial sternal border to the medial IMv was greater (9.49±2.28 mm vs. 7.18±2.13 mm, respectively; P<0.001). Bifurcations of the IMv were found in 18.4% of cases at the second ICS and in 63.2% of cases at the third ICS.Conclusions The IMVs at the second ICS had more favorable anatomic features for use as recipient vessels in DIEP flap breast reconstruction than those at the third ICS.

DIEP Flap Breast Reconstruction Complication Rate in Previously Irradiated Internal Mammary Nodes

2018 ◽  
Vol 34 (06) ◽  
pp. 399-403 ◽  
Author(s):  
Shirley Shechter ◽  
Ehud Arad ◽  
Amir Inbal ◽  
Or Friedman ◽  
Eyal Gur ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Control Group ◽  
Diep Flap ◽  
Study Group ◽  
Fat Necrosis ◽  
Internal Mammary Nodes ◽  
Internal Mammary ◽  
Delayed Breast Reconstruction ◽  
Internal Mammary Vessels

Background Postmastectomy radiation therapy (PMRT) is a widely accepted treatment for locally advanced breast cancer. Some patients require additional boost radiation to the internal mammary nodes as the part of regional nodal irradiation (RNI). Delayed breast reconstruction with an autologous free flap using the internal mammary vessels for microvascular flap anastomosis is a common practice for these patients. The aim of our study was to evaluate the effect of RNI on autologous microvascular breast reconstruction. Patients and Methods A retrospective study was performed on 57 patients (69 flaps) undergoing deep inferior epigastric perforator (DIEP) flap for delayed breast reconstruction after radiation therapy. The study group included 37 patients (65%) who received PMRT and RNI to the internal mammary nodes. The control group included 20 patients (35%) who received PMRT alone. Early and delayed surgical complications, including wound complications, fat necrosis, and flap loss, were compared between the groups. Results The patient demographics in both groups were similar. Complication rate showed a higher trend in the study group for flap loss (8.3% versus 0%) and vascular anastomosis failure (5.6% versus 0%), but with no statistical difference (p = 0.54, 0.53, respectively). The control group showed a higher trend in fat necrosis (25% versus 8.3%, p = 0.11). Conclusions DIEP flap breast reconstructions with internal mammary vessels anastomosis should be performed with cautious in patients who had received RNI to internal mammary nodes because of potential added risk for surgical complications.

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