scholarly journals Donor-site morbidity of the inferior gluteal artery perforator flap for breast reconstruction in teenagers

2013 ◽  
Vol 21 (1) ◽  
pp. 19-22 ◽  
Author(s):  
Emilie Godbout ◽  
Lucie Farmer ◽  
Patricia Bortoluzzi ◽  
Louise Caouette Laberge
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Inferior Gluteal Artery ◽  
Artery Perforator

Donor Site Morbidity after Lumbar Artery Perforator Flap Breast Reconstruction

2021 ◽  
Author(s):  
Dries Opsomer ◽  
Tom Vyncke ◽  
Michelle Ryx ◽  
Koenraad Van Landuyt ◽  
Phillip Blondeel ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Significant Risk ◽  
Perforator Flap ◽  
Significant Risk Factor ◽  
Donor Site Morbidity ◽  
Diep Flap ◽  
Lumbar Artery ◽  
Patient Reported ◽  
Artery Perforator

Abstract Background The lumbar artery perforator flap is a second-choice flap in autologous breast reconstruction whenever a deep inferior epigastric artery perforator (DIEP) flap is not possible. Ideal candidates are pear-shaped women who do not have enough bulk on the abdomen or thighs. Patient-reported “satisfaction with breasts” is excellent but we were curious about the donor site morbidity. Methods We performed a retrospective study of all lumbar flap breast reconstructions performed between 2010 and 2019. Patients were invited by e-mail and telephone to take part in a BREAST-Q survey. Results One hundred fifty-four flaps were performed in 110 patients. Sixty-three patients filled out the BREAST-Q questionnaire. The most frequently observed donor site complications are seroma (35.1%), dehiscence (8.4%), and hematoma (3.2%). Correction of the donor site scar was performed in 31.8% of patients, lipofilling of the donor flank in 5.2%, and liposuction of the contralateral flank in 18.3% of patients. Body mass index (BMI) was the only significant risk factor for donor site complications. Patient-reported “satisfaction with donor site appearance” was good but significantly lower for primary reconstructions compared with secondary and tertiary procedures. Flap weight significantly influences patient-reported “physical wellbeing of the donor site.” Ninety-seven percent of patients would recommend the surgery to someone in a similar position and would do it all over. Conclusion The lumbar artery perforator flap is a good alternative for breast reconstruction in selected patients. The donor site issues consist mainly of seromas, prolonged discomfort, and a scar that might be noticeable to others, but patient-reported satisfaction is very high.

Anterior Intercostal Artery Perforator Flap as a Simple Technique for Partial Breast Reconstruction: Our Institutional Initial Experience

2020 ◽  
Vol 106 (1_suppl) ◽  
pp. 40-40
Author(s):  
R Amira Maher ◽  
Ahmed Gamal Eldin Osman ◽  
K Fahmy ◽  
Nouf M. Ebied ◽  
Reda Eissa
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Perforator Flap ◽  
Cosmetic Outcome ◽  
University Hospital ◽  
Intercostal Artery ◽  
Breast Size ◽  
Cancer Management ◽  
The Mean ◽  
Artery Perforator

Background: The oncoplastic surgery has brought new dimensions to breast conserving surgery and added the aesthetic principles of breast surgery to breast cancer management. Recently there's a lot of volume replacement techniques without significant donor site morbidity .The anterior intercostal artery perforator (AICAP) flap is a suitable option in partial breast reconstruction for lower pole tumors in small and medium sized breasts. Objectives: The aim of this study is to report our clinical experience with anterior intercostal perforator flap in partial breast reconstruction Methodology: 25 cases were performed between April 2018 to June 2019 at in Ain shams university hospitals for selected patients with lower breast pole tumors with small and medium sized breast and other option like reduction mMDTmoplasty wasn't favorable for them. Results: A total of 25 patient were selected by the multidisplinary team at Ain shams university hospital for partial breast reconstruction with anterior intercostal artery perforator flap . The mean age of the cases was 45.68 with mean body mass index of 32.32. The mean operative time for the flap was 64 minutes while the hospital stay was ranging from 1-2 days .Follow-up for local recurrence was from 6 to 14 months. There was 1 case with wound complication (4%). The cosmetic outcome was assessed by the MDT and a giving score from 1-5 was used with 1 is the least favorable cosmetic outcome and 5 is the best result 76% of the cases scored 5, 14% scored 4, 8% scored 3. According to patient satisfaction a score from 1 to 5 was used with the score 1 is least satisfied and score 5 represents the most satisfaction level, there was 80% of the patient gave the score 5, 12% of the cases gave the score 4 and 8% of the cases gave the score 3 Conclusions: Based on our experience, partial breast reconstruction using AICAP flap is a reliable option for lower breast tumors in small-to-moderate breast size with perfect cosmetic outcome and negligible rate of complication.

Alternative flaps for microsurgical breast reconstruction

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.

Use of Indocyanine Green Imaging for Perforator Identification in Preexpanded Brachial Artery Perforator Flaps

2020 ◽  
Vol 36 (05) ◽  
pp. 650-658
Author(s):  
Tinglu Han ◽  
Nima Khavanin ◽  
Mengqing Zang ◽  
Shan Zhu ◽  
Bo Chen ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Head And Neck ◽  
Brachial Artery ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Icg Angiography ◽  
Flap Design ◽  
Flap Elevation ◽  
Artery Perforator

AbstractThe tissues of the medial arm as a donor site for perforator flap design have several advantages. However, they are relatively underused with limited reports, partly due to unreliable perforator anatomy. Therefore, we aimed to review our preliminary experience using indocyanine green (ICG) angiography to design and elevate preexpanded pedicled brachial artery perforator (BAP) flaps for regional reconstruction. All patients underwent soft tissue reconstructions using a preexpanded BAP flap in two or three stages. ICG angiography was used to localize perforators during both expander insertion and flap elevation. The pedicle was divided at the third stage 3 weeks following flap elevation for head and neck cases. Sixteen patients underwent reconstructions of the head and neck (n = 13) or shoulder/trunk (n = 3) using 14 perforator-plus and 2 propeller BAP flaps. In total, 50 perforators were identified using ICG imaging, all of which were appreciable during both expander placement and flap elevation. Thirty-five perforators were directly visualized during flap elevation, and an additional 15 perforators were not explored but incorporated into the flap. All flaps survived without necrosis, and the donor sites healed uneventfully without complications. The medial arm provides thin and pliable skin for the resurfacing of regional defects with relatively minimal donor-site morbidity. With the assistance of ICG angiography, perforators of the brachial artery can be reliably identified, facilitating the preexpansion and elevation of pedicled BAP flaps for use in head–neck and trunk reconstruction.

Analysis of patient satisfaction and donor-site morbidity after different types of breast reconstruction

2014 ◽  
Vol 103 (4) ◽  
pp. 249-255 ◽  
Author(s):  
H. C. Benditte-Klepetko ◽  
F. Lutgendorff ◽  
T. Kästenbauer ◽  
M. Deutinger ◽  
C. M. A. M. van der Horst
Keyword(s):  
Quality Of Life ◽  
Patient Satisfaction ◽  
Breast Reconstruction ◽  
Latissimus Dorsi ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Deep Inferior Epigastric Perforator ◽  
Types Of Breast Reconstruction

Background and Aims: Breast reconstruction has been shown to improve quality of life. However, factors involved in long-term patient satisfaction are largely unknown. Our aim was to evaluate patient satisfaction and donor-site morbidity in five types of breast reconstruction. Material and Methods: A prospectively collected database of all breast surgery patients at Hospital Rudolfstiftung, Vienna, Austria, was searched for five types of breast reconstruction (2000–2006): implant, latissimus dorsi-flap, latissimus dorsi-flap with implant, free transverse rectus abdominis musculocutaneous-flap, and deep inferior epigastric perforator-flap. Patients were sent a study-specific questionnaire to assess satisfaction. Short-form 36-item health survey was used to analyze (quality of life), and complication data were retrieved from the database and assessed during a follow-up visit. Results: There were 257 patients identified, of whom, 126 responded to the survey (17 implant, 5 latissimus dorsi + implant, 64 latissimus dorsi, 22 transverse rectus abdominis musculocutaneous, and 18 deep inferior epigastric perforator reconstructions). No statistical differences were found in complication or reoperation rates. Deep inferior epigastric perforator–flap patients were significantly more satisfied compared to patients from the implant group ( p = 0.007). However, there was no significant difference regarding quality of life scores among the groups. After logistic regression analysis, only “impairment on daily life” showed to be independently correlated with patient satisfaction. This contrary to both operation type and complication rate which did not correlate with patient satisfaction. Conclusions: Our results indicate that operation type, complication rate, and revision rate did not independently correlate with patient satisfaction. Therefore, to further improve patient satisfaction, future research should be focused on other pro-operative factors, for example, patient education, expectations, and personality characteristics.

Time and Speed of Vascular Pedicle Dissection in Deep Inferior Epigastric Artery Perforator Flap Elevation

2017 ◽  
Vol 33 (08) ◽  
pp. 557-562
Author(s):  
Ji Yim ◽  
Yeon Lee ◽  
Young Kim ◽  
Eun Kim ◽  
Taik Lee ◽  
...  
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
Vascular Pedicle ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Artery ◽  
Time Required ◽  
Artery Perforator

Background Breast reconstruction using deep inferior epigastric artery perforator (DIEP) free flap is widely used because of the advantages of minimizing donor-site morbidity, but it requires technical competency in vascular dissection. This study evaluated the influence of patient factors and vascular status on the time and speed of dissection of the vascular pedicle. Methods DIEP free flap procedures were performed in 49 patients assigned to immediate or delayed reconstruction groups. Factors that significantly influenced the time required and the speed of dissection were evaluated. Results The average total dissection time was 55.9 minutes (34.5 minutes for the intramuscular dissection and 21.4 minutes for the submuscular dissection). The dissection speed for the total vascular pedicle was 2.65 cm/10 minutes (1.71 cm/10 minutes for the intramuscular dissection and 4.30 cm/10 minutes for the submuscular dissection). The presence of a Pfannenstiel scar, length of the vascular pedicle in the intramuscular area, and the number of microclips used significantly correlated with the total dissection time. Conclusion The length of the intramuscular pedicle, number of microclips used, and presence of a Pfannenstiel scar significantly correlated with the total dissection time of the vascular pedicle. An assessment prior to the surgery can reduce the time of operation and make it easier to elevate the flap.

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