scholarly journals Diametric Comparison between the Thoracodorsal Vessel and Deep Inferior Epigastric Vessel in Breast Reconstruction

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jun Hyeok Kim ◽  
Ye Sol Kim ◽  
Suk-Ho Moon ◽  
Young Joon Jun ◽  
Jong Won Rhie ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Free Tissue Transfer ◽  
Diep Flap ◽  
Serratus Anterior Muscle ◽  
Serratus Anterior ◽  
Epigastric Vessel ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Size Discrepancy ◽  
The Difference

Background. In microvascular anastomosis, size discrepancy is common and can increase thrombotic complications. If size differences can be predicted, then vessels of the appropriate size can be selected. This study documented the difference in diameter between the thoracodorsal (TD) vessel and deep inferior epigastric perforator (DIEP) pedicle in each patient who underwent breast reconstruction using free tissue transfer. Patients and Methods. This retrospective study included 32 anastomoses (27 breasts including five cases of supercharged anastomosis) of breast reconstruction with the free DIEP flap and TD recipient between August 2018 and June 2019. In the microscopic view, the caliber of the TD vessel, the largest branch to the serratus anterior muscle, the descending branch, the largest and the second largest branches to the latissimus dorsi muscle, and the DIEP pedicle were measured. Results. The diameter of the deep inferior epigastric artery was similar to that of the descending branch, and their anastomosing rate was 56.3%. The diameter of the deep inferior epigastric vein was similar to the branch to the serratus anterior muscle and the descending branch, and their anastomosing rates were 29.3% and 29.3%, respectively. All flaps were survived; however, in one case, a reoperation was needed to remove the hematoma, in which case fat necrosis occurred as the only complication. Conclusion. TD branches of similar size to the DIEP pedicle were prioritized in anastomosis. The descending branch and the branch to the serratus anterior muscle are expected to be good candidates as recipients in breast reconstruction with DIEP free flap. Moreover, supercharged anastomosis of DIEP pedicles can be achieved within TD branches.

scholarly journals Does surgical procedure type impact postoperative pain and recovery in deep inferior epigastric artery perforator flap breast reconstruction?

2020 ◽  
Vol 47 (4) ◽  
pp. 324-332
Author(s):  
Alexander A. Azizi ◽  
Anita T. Mohan ◽  
Taj Tomouk ◽  
Elizabeth B. Brickley ◽  
Charles M. Malata
Keyword(s):  
Postoperative Pain ◽  
Breast Reconstruction ◽  
Hospital Stay ◽  
Diep Flap ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Significant Difference ◽  
Deep Inferior Epigastric Artery ◽  
Postoperative Morphine ◽  
Artery Perforator

Background The deep inferior epigastric artery perforator (DIEP) flap is the commonest flap used for breast reconstruction after mastectomy. It is performed as a unilateral (based on one [unipedicled] or two [bipedicled] vascular pedicles) or bilateral procedure following unilateral or bilateral mastectomies. No previous studies have comprehensively analyzed analgesia requirements and hospital stay of these three forms of surgical reconstruction.Methods A 7-year retrospective cohort study (2008–2015) of a single-surgeon’s DIEP-patients was conducted. Patient-reported pain scores, patient-controlled morphine requirements and recovery times were compared using non-parametric statistics and multivariable regression.Results The study included 135 participants: unilateral unipedicled (n=84), unilateral bipedicled (n=24) and bilateral unipedicled (n=27). Univariate comparison of the three DIEP types showed a significant difference in 12-hour postoperative morphine requirements (P=0.020); bipedicled unilateral patients used significantly less morphine than unipedicled (unilateral) patients at 12 (P=0.005), 24 (P=0.020), and 48 (P=0.046) hours. Multivariable regression comparing these two groups revealed that both reconstruction type and smoking status were significant predictors for 12-hour postoperative morphine usage (P=0.038 and P=0.049, respectively), but only smoking, remained significant at 24 (P=0.010) and 48 (P=0.010) hours. Bilateral reconstruction patients’ mean hospital stay was 2 days longer than either unilateral reconstruction (P<0.001).Conclusions Although all three forms of DIEP flap breast reconstruction had similar postoperative pain measures, a novel finding of our study was that bipedicled DIEP flap harvest might be associated with lower early postoperative morphine requirements. Bilateral and bipedicled procedures in appropriate patients might therefore be undertaken without significantly increased pain/morbidity compared to unilateral unipedicled reconstructions.

The use of the serratus anterior muscle vascular pedicle as recipient site in DIEP flap transfer for breast reconstruction

2014 ◽  
Vol 67 (4) ◽  
pp. 456-460 ◽  
Author(s):  
Fabio Santanelli di Pompeo ◽  
Benedetto Longo ◽  
Rosaria Laporta ◽  
Marco Pagnoni ◽  
Enrico Cavalieri
Keyword(s):  
Breast Reconstruction ◽  
Diep Flap ◽  
Vascular Pedicle ◽  
Serratus Anterior Muscle ◽  
Serratus Anterior ◽  
Recipient Site ◽  
Flap Transfer

Contribution of Simultaneous Breast Reconstruction by Deep Inferior Epigastric Artery Perforator Flap to the Efficacy of Vascularized Lymph Node Transfer in Patients with Breast Cancer-Related Lymphedema

2017 ◽  
Vol 33 (08) ◽  
pp. 571-578 ◽  
Author(s):  
Hideki Tokumoto ◽  
Yoshihisa Yamaji ◽  
Yoshitaro Sasahara ◽  
Yoshitaka Kubota ◽  
Maiko Kubo ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Compression Therapy ◽  
Diep Flap ◽  
Advanced Stage ◽  
Groin Flap ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Breast Cancer Related Lymphedema ◽  
Lymph Node Transfer ◽  
Artery Perforator

Background The contribution of simultaneous breast reconstruction by deep inferior epigastric artery perforator (DIEP) flap to the efficacy of vascularized groin lymph node transfer (LNT) for breast cancer-related lymphedema (BCRL) was investigated. Methods Patients were divided into two groups: the first group underwent groin LNT + DIEP flap surgery for simultaneous breast reconstruction (groin LNT + DIEP flap group) and the second group underwent groin LNT only (groin flap alone group). Patients with BCRL were evaluated based on indocyanine green lymphography findings. LNT was indicated only in advanced-stage BCRL cases, and groin nodes nourished by superficial circumflex iliac artery (SCIA) were used as donors. The side for the vascular pedicle(s) was decided based on our algorithm. In patients with pendulous breast, the flap was vertically transferred on the chest. Lymphatic function was assessed after LNT using imaging tests, and transferred lymph nodes were evaluated using ultrasonography. Results In this study, 27 patients with advanced-stage BCRL underwent LNT. Of them, 13 belonged to the groin LNT + DIEP flap group and 14 belonged to the groin flap alone group. Although reduction volume was not significantly different between the groups, the number of patients in whom lymphatic function was improved and the need for compression therapy could be reduced was significantly higher in the groin LNT + DIEP flap group than in the groin flap alone group. Conclusion When a patient with advanced-stage BCRL undergoes LNT based on SCIA, simultaneous breast reconstruction using DIEP flap may reduce the need for compression therapy.

scholarly journals Conventional CT versus Dedicated CT Angiography in DIEP Flap Planning: A Feasibility Study

2021 ◽  
Vol 11 (4) ◽  
pp. 277
Author(s):  
Anna D’Angelo ◽  
Alessandro Cina ◽  
Giulia Macrì ◽  
Paolo Belli ◽  
Sara Mercogliano ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Ct Angiography ◽  
Surgical Techniques ◽  
Diep Flap ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Preoperative Mapping ◽  
Lower Accuracy ◽  
Deep Inferior Epigastric Artery ◽  
Conventional Ct

The deep inferior epigastric perforator (DIEP) flap is used with increasing frequency in post-mastectomy breast reconstruction. Preoperative mapping with CT angiography (CTa) is crucial in reducing surgical complications and optimizing surgical techniques. Our study’s goal was to investigate the accuracy of conventional CT (cCT), performed during disease staging, compared to CTa in preoperative DIEP flap planning. In this retrospective, single-center study, we enrolled patients scheduled for mastectomy and DIEP flap breast reconstruction, subjected to cCT within 24 months after CTa. We included 35 patients in the study. cCT accuracy was 95% (CI 0.80–0.98) in assessing the three largest perforators, 100% (CI 0.89–100) in assessing the dominant perforator, 93% (CI 0.71–0.94) in assessing the perforator intramuscular course, and 90.6% (CI 0.79–0.98) in assessing superficial venous communications. Superficial inferior epigastric artery (SIEA) caliber was recognized in 90% of cases (CI 0.84–0.99), with an excellent assessment of superficial inferior epigastric vein (SIEV) integrity (96% of cases, CI 0.84–0.99), and a lower accuracy in the evaluation of deep inferior epigastric artery (DIEA) branching type (85% of cases, CI 0.69–0.93). The mean X-ray dose spared would have been 788 ± 255 mGy/cm. Our study shows that cCT is as accurate as CTa in DIEP flap surgery planning.

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.

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