Comprehensive Analysis of Donor-Site Morbidity in Abdominally Based Free Flap Breast Reconstruction

AbstractFree tissue transfer serves as a modern workhorse for breast reconstruction. Advancements in microsurgical technique have allowed for the development of free flap procedures that produce an aesthetic breast while minimizing donor site morbidity. Here, the authors review the use of different free flap procedures for breast reconstruction with a focus on the preferred and most commonly used flap, the deep inferior epigastric perforator flap. Each flap has its advantages and drawbacks, and certain patient risk factors increase postoperative complications. Other techniques of breast reconstruction including pedicled flaps and adjunctive fat grafting are also briefly discussed.

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Safety of a Modified Lipoabdominoplasty Technique for Donor-Site Closure in Abdominal-Based Free Flap Breast Reconstruction

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02117-y ◽

2021 ◽

Cited By ~ 1

Author(s):

Dimitra Kotsougiani-Fischer ◽

Laura Sieber ◽

Sebastian Fischer ◽

Christoph Hirche ◽

Spyridoula Maraka ◽

...

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Donor Site

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LONG-TERM DONOR-SITE MORBIDITY IN COMPOSITE ANTEROLATERAL THIGH FREE FLAP FOR COMPLEX DEFECT OF LOWER LEG AND FOOT RECONSTRUCTION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2020.5.12 ◽

2020 ◽

pp. 85-91

Author(s):

Phuc Le Hong ◽

Son Tran Thiet ◽

Thuy Nguyen Xuan

Keyword(s):

Soft Tissue ◽

Skin Graft ◽

Free Flap ◽

Donor Site ◽

Lower Extremities ◽

Lower Leg ◽

Donor Site Morbidity ◽

Thigh Circumference ◽

Anterolateral Thigh

Background: In recent years, the composite anterolateral thigh free flap with tensor fasciae latae or vastus lateralis has been a new-applied type of flap that can provide very good reconstruction materials in complex defects of lower leg and foot. The study purpose is to evaluate the systematically complications of donor site, related factors to results of the donor area, in order to apply the result to improve the treatment, which have not been much reported in literature. Materials and Methods: Systematic donor site morbilidy evaluation in a prospective, uncontrolled clinical descriptive study of 33 composite anterolateral thigh free flaps in various forms to reconstruct anatomical structures or to resconstruct deep defects combined with covering the surfaces for complex soft tissue defects in lower extremities for 32 patients due to different causes in lower leg and foot area from 2014-2019 at Hue University of Medicine and Pharmacy. Examining and evaluating aesthetic and functional result of donor-site 3 months and 6 months up to 2 year after surgery; evaluating the correlation between the width and the type of the flaps and donor site closure methods. Result: In 33 composite flaps used, flap width to thigh circumference less than 20% in 27 cases (81.8%), more than 20% in 6 cases (18.20% ); There were 28 cases in which the donor site was directly closed, 5 cases required skin graft; All direct closed cases had flap width/ thigh circumference index below 20%; On the contrary, in cases having this index greater than 20%, the donor site required skin graft with p < 0.01. There are 11/33 (33.33%) of cases reported complications in donor site ; lateral thigh paresthesia is the most complicated complication with 8/33 cases (24.24%), followed by bad scarring 3/33 cases (9.09%). Conclusion: Long term follow up donor site morbility after composite anterior thigh free flap present 11/33 cases (33.33%): mostly complications of the donor site are thigh paresthesia with 8/33 cases (24.24%), and bad scarring 3/33 cases (9,09%), which improve time by time. Keywords: Composite anterior thigh free flap, lower extremities soft tissue defect, donor site morbidity

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Autologous Unilateral Breast Reconstruction with Venous Supercharged IMAP-Flaps: A Step by Step Guide of the Split Breast Technique

Journal of Clinical Medicine ◽

10.3390/jcm9093030 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3030

Author(s):

Kathrin Bachleitner ◽

Laurenz Weitgasser ◽

Amro Amr ◽

Thomas Schoeller

Keyword(s):

Breast Cancer ◽

Surgical Technique ◽

Breast Reconstruction ◽

Donor Site ◽

Operating Time ◽

Cancer Recurrence ◽

Free Tissue Transfer ◽

Donor Site Morbidity ◽

Aesthetic Result ◽

Secondary Operations

Various techniques for breast reconstruction ranging from reconstruction with implants to free tissue transfer, with the disadvantage of either carrying a foreign body or dealing with donor site morbidity, have been described. In patients who had a unilateral mastectomy and offer a contralateral mamma hypertrophy a breast reconstruction can be performed with the excess tissue from the hypertrophic side using the split breast technique. Here a local internal mammary artery perforator (IMAP) flap of the hypertrophic breast can be used for reconstruction avoiding the downsides of implants or a microsurgical reconstruction and simultaneously reducing the enlarged donor breast in order to achieve symmetry. Methods: Between April 2010 and February 2019 the split breast technique was performed in five patients after mastectomy due to breast cancer. Operating time, length of stay, complications and the need for secondary operations were analyzed and the surgical technique including flap supercharging were described in detail. Results: All five IMAP-flaps survived and an aesthetically pleasant result could be achieved using the split breast technique. An average of two secondary corrections to achieve better symmetry were necessary after each breast reconstruction. Complications included venous flap congestion, partial flap necrosis and asymmetry. No breast cancer recurrence was recorded. An overall approval of the surgical technique among patients was observed. Conclusions: The use of the contralateral breast for unilateral total breast reconstruction represents an additional highly useful technique for selected patients, is safe and reliable results can be achieved. Although this technique is carried out as a single-stage procedure, including breast reduction and reconstruction at the same time, secondary operations may be necessary to achieve superior symmetry and a satisfying aesthetic result. Survival of the IMAP-flaps can be improved by venous supercharging of the flaps onto the thoracoepigastric vein.

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Rational selection of flaps from the abdomen in breast reconstruction to reduce donor site morbidity

British Journal of Plastic Surgery ◽

10.1054/bjps.1999.3099 ◽

1999 ◽

Vol 52 (5) ◽

pp. 351-354 ◽

Cited By ~ 84

Author(s):

Z.M. Arnez ◽

U. Khan ◽

D. Pogorelec ◽

F. Planinsek

Keyword(s):

Breast Reconstruction ◽

Donor Site ◽

Donor Site Morbidity ◽

Rational Selection ◽

Selection Of

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Comprehensive Analysis of Donor-Site Morbidity following Free Thoracodorsal Artery Perforator Flap Harvest

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000002396 ◽

2016 ◽

Vol 138 (4) ◽

pp. 899-909 ◽

Cited By ~ 7

Author(s):

Kyeong-Tae Lee ◽

Ara Kim ◽

Goo-Hyun Mun

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

Comprehensive Analysis ◽

Thoracodorsal Artery ◽

Thoracodorsal Artery Perforator Flap ◽

Artery Perforator

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DIEP and Muscle Sparing Breast Free Flap

Operative Plastic Surgery ◽

10.1093/med/9780190499075.003.0075 ◽

2019 ◽

pp. 781-794

Author(s):

Maurice Y. Nahabedian

Keyword(s):

Breast Reconstruction ◽

Free Flap ◽

Donor Site ◽

The Other ◽

No Donor ◽

Technical Aspects ◽

Body Habitus ◽

Deep Inferior Epigastric Perforator ◽

Muscle Sparing

The deep inferior epigastric perforator (DIEP) and muscle-sparing (MS) free transverse rectus abdominis musculocutaneous (TRAM) flaps are arguably the most common flaps used for autologous breast reconstruction. The benefit of these flaps is that very little to no donor site muscle is harvested. The decision to use one or the other is occasionally made preoperatively based on body habitus but often intraoperatively based on the quality of the perforating vessels. The technical aspects of the operation are similar except for the actual dissection around the perforating vessels. Studies have demonstrated no significant differences in outcome when comparing the DIEP and MS free TRAM flaps.

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Alternative flaps for microsurgical breast reconstruction

10.1093/med/9780199682874.003.0093 ◽

2021 ◽

pp. 1107-1114

Author(s):

Hinne A. Rakhorst

Keyword(s):

Breast Reconstruction ◽

Standard Care ◽

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

The Body ◽

Diep Flap ◽

Deep Inferior Epigastric Perforator ◽

Muscle Sparing ◽

Breast Reconstructive Surgery

Microsurgery in general has made dramatic improvements over the past decades. This applies to microsurgery in general and to breast reconstructive surgery especially. The demand for autologous breast reconstruction has risen. Since the introduction of the free transverse rectus abdominis myocutaneous (TRAM) flaps, through the muscle-sparing TRAM, flaps designs have evolved into the current gold standard, the deep inferior epigastric perforator (DIEP) flap. From experiences and increasing numbers of flap procedures performed by surgeons, techniques became more familiar and part of standard care. These factors gave rise to the development of a growing number of areas of the body where tissues of interest can be harvested using perforator flap-based techniques. This chapter discusses the most common as well as the ‘rising stars’ in terms of flaps to be used as alternative flaps to the DIEP flap for breast reconstruction. It discusses practical issues on dissection as well as donor site morbidity.

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