Strategy in Determining the Reliability of SIEA Flap Utilization

Abstract Background Free flap-mediated gene therapy in the tumor bed following surgical resection is a promising approach in cancer targeted treatment of residual disease. We investigated the selective killing efficacy of a lentivirus-mediated cytosine deaminase-thymidine kinase (CDglyTK) gene in transplanted breast cancer delivered into a free flap by intra-artery perfusion. Methods Proliferation, apoptosis, and cell cycle of rat SHZ-88 breast cancer cells transfected with a lentivirus-mediated CD/TK gene were measured following treatment with ganciclovir and 5-flucytosine in vitro. A model of residual disease of breast cancer in a rat superficial inferior epigastric artery (SIEA) flap model was used to study the therapeutic potential of a double suicide CD/TK and prodrug system in vivo. Results Killing efficacy of the double suicide CD/TK and prodrug system on SHZ-88 cells was mediated by increased apoptosis and cell cycle arrest at the G1 phase with significant bystander effect. Following recombinant lentivirus transfection of rat SIEA flap by intra-artery perfusion, CD/TK gene expression was limited to the flap, and the volume and weight of transplanted tumors were significantly reduced without observable toxicity. Conclusions SIEA flaps transfected with a lentivirus-mediated CDglyTK gene by intra-artery perfusion effectively suppress transplanted breast tumor growth without obvious systemic toxic effects in rats.

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Predicting and planning for SIEA flap utilisation in breast reconstruction: An algorithm combining pre-operative computed tomography analysis and intra-operative angiosome assessment

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2017.03.011 ◽

2017 ◽

Vol 70 (6) ◽

pp. 795-800 ◽

Cited By ~ 7

Author(s):

Francis P. Henry ◽

Daniel P. Butler ◽

Simon H. Wood ◽

Navid Jallali

Keyword(s):

Computed Tomography ◽

Breast Reconstruction ◽

Siea Flap ◽

Tomography Analysis

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Preserving the Internal Mammary Artery End-to-Side Microvascular Arterial Anastomosis for DIEP and SIEA Flap Breast Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e318254fa3f ◽

2012 ◽

Vol 130 (1) ◽

pp. 187e-188e ◽

Cited By ~ 1

Author(s):

Jonathan Bank ◽

Sandeep Nathan ◽

David H. Song

Keyword(s):

Breast Reconstruction ◽

Internal Mammary Artery ◽

Internal Mammary ◽

Siea Flap ◽

Arterial Anastomosis

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Optimizing Outcomes in Free Flap Breast Reconstruction in the Community Hospital Setting: A Stepwise Approach to DIEP/SIEA Flap Procedures with Banking a Hemiabdominal Flap

Journal of Reconstructive Microsurgery ◽

10.1055/s-0037-1602588 ◽

2017 ◽

Vol 33 (07) ◽

pp. 474-482

Author(s):

Alberto Okada ◽

Diego Pereira ◽

Eduardo Montag ◽

Marcelo Portocarrero ◽

Carlos Felício ◽

...

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Donor Site ◽

Hospital Setting ◽

Smoking History ◽

Early Complications ◽

Community Hospitals ◽

Immediate Reconstruction ◽

Conventional Procedure ◽

Siea Flap

Background Free flap breast reconstruction is a conventional procedure in many countries; however, microvascular compromise remains a devastating outcome. Given the morbidity of total necrosis, optimizing free flap salvage stands out as an important area for research, especially among surgeons to overcome the learning curve period and in resource constrained scenario such as community hospitals. To ensure free deep inferior epigastric perforator (DIEP)/superficial inferior epigastric artery (SIEA) flap breast reconstruction, the authors present a technique involving raising a hemiabdominal flap as a free flap, and banking the remaining flap to be utilized if needed in a subsequent procedure. Methods A retrospective review was performed on all free flap breast reconstructions. In this period, 84 patients (mean age: 50.1 ± 8 years) were included. Results In this study, 65.5% patients underwent immediate reconstruction, and 51.2% received DIEP reconstruction; 9.52% patients were returned to the operating room, and salvage reconstruction using the banked flap was performed in all patients. No differences were observed regarding early complications and age, body mass index, American Society of Anesthesiologists status, diabetes, smoking history, chemotherapy, radiotherapy, and type of flap used (p > 0.05). Hypertension was significantly associated with early complications (p < 0.05). Donor-site complications were associated with RT (p < 0.05). Conclusion The banked flap is a reliable method for ensuring DIEP/SIEA flap survival and should be considered in higher risk reconstructions and community hospitals. We believe that the present technique can be a good addition to the arsenal of plastic surgeons dealing with free flap breast reconstructions in selected patients.

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Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction

Archives of Plastic Surgery ◽

10.5999/aps.2019.01319 ◽

2020 ◽

Vol 47 (5) ◽

pp. 473-482

Author(s):

Ya-han Yu ◽

Dina Ghorra ◽

Christine Bojanic ◽

Oti N. Aria ◽

Louise MacLennan ◽

...

Keyword(s):

Breast Reconstruction ◽

Free Flaps ◽

Inferior Epigastric Artery ◽

Skin Paddle ◽

Epigastric Artery ◽

Internal Mammary ◽

Siea Flap ◽

Deep Inferior Epigastric Perforator ◽

Nipple Sparing Mastectomy ◽

Nipple Sparing

Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy.

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