scholarly journals Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis

2020 ◽  
Vol 9 (7) ◽  
pp. 2031
Author(s):  
Laurenz Weitgasser ◽  
Karl Schwaiger ◽  
Fabian Medved ◽  
Felix Hamler ◽  
Gottfried Wechselberger ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Operative Time ◽  
Donor Site ◽  
Patient Characteristics ◽  
Study Groups ◽  
Donor Site Morbidity ◽  
Fat Grafting ◽  
Deep Inferior Epigastric Perforator ◽  
Group 2 ◽  
Group 1

Background: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome. Patients and Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated. Results: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% (p = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded (p = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, p = 0.0047, RR 1.71). Conclusion: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions.

scholarly journals Free Tissue Breast Reconstruction

2019 ◽  
Vol 33 (01) ◽  
pp. 059-066 ◽  
Author(s):  
Rami Dibbs ◽  
Jeff Trost ◽  
Valerie DeGregorio ◽  
Shayan Izaddoost
Keyword(s):  
Breast Reconstruction ◽  
Free Flap ◽  
Donor Site ◽  
Perforator Flap ◽  
Free Tissue Transfer ◽  
Donor Site Morbidity ◽  
Fat Grafting ◽  
Microsurgical Technique ◽  
Deep Inferior Epigastric Perforator ◽  
Aesthetic Breast

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.

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.

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.

scholarly journals Laparoscopic Harvesting of Omental Flaps for Breast Reconstruction—A Review of the Literature and Outcome Analysis

2017 ◽  
Vol 26 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Hani Shash ◽  
Becher Al-halabi ◽  
Salah Aldekhayel ◽  
Tassos Dionisopoulos
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Patient Characteristics ◽  
Donor Site Morbidity ◽  
Outcome Analysis ◽  
Complication Rates ◽  
Search Terms ◽  
The Mean ◽  
Pedicle Flaps

Background: Evidence on the use of omental flaps for breast reconstruction in patients with breast cancer is lacking, and no published reviews report an outcome-based assessment of such flap. This review explores available data and evidence for change in complication rates following the shift toward laparoscopic harvesting. Methods: We searched the databases Excerpta Medica database, MEDLINE, and PubMed from inception until December 2015 using search terms “omental flaps“ and “breast reconstruction.” Data extracted were patient characteristics, technique used, and outcome measures reported and were then analyzed based on the technique of harvesting. Results: Twenty-two articles reporting 651 patients who underwent mastectomies and breast-conserving surgeries were included in this review. Most flaps, 537 (82.5%), were harvested by laparoscopy, and 626 (96.2%) of the flaps were pedicle flaps. The mean age was 47.7 years (standard deviation: 4.29), and mean follow-up was 38.1 months. There were 88 reported complications among 562 patients in 16 reports. The rate of any complication was calculated to be 15.0%, with a higher rate (29.1%) occurring with the open technique in comparison to laparoscopy (12.6%). The commonest complications were postoperative infection and breast firmness each reported in 2.22%. Most authors reported advantages of malleability and excellent aesthetic outcomes and disadvantages in terms of inability to estimate the volume of the flap and variability in size. Conclusion: Omentum use is safe and has advantages in breast reconstruction where other options are limited including a natural feeling and minimal donor site morbidity if harvested laparoscopically.

Myocutaneous Gracilis Free Flaps in Microsurgical Breast Reconstruction: A Systematic Review Comparing Variations of the Upper Gracilis Flap

2017 ◽  
Vol 33 (09) ◽  
pp. 630-635 ◽  
Author(s):  
Vicky Kang ◽  
Emilie Robinson ◽  
Eric Barker ◽  
Anuja Antony
Keyword(s):  
Systematic Review ◽  
Breast Reconstruction ◽  
Donor Site ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Fat Grafting ◽  
Complication Rates ◽  
Implant Placement ◽  
Pubmed Database ◽  
Low Incidence

Background The transverse upper gracilis (TUG) flap has gained increasing acceptance as a reliable option for breast reconstruction, specifically in patients without adequate abdominal tissue. Three major flap designs of the upper gracilis flap have been proposed to balance volume needs with flap vascularity. A systematic review was performed to identify outcomes of the major gracilis flaps: TUG, vertical-transverse upper gracilis (V-TUG), and longitudinal gracilis myocutaneous (LGM) flaps. This study is the first and only systematic review to date reviewing the variations of the upper gracilis flap in microsurgical breast reconstruction. Methods A systematic review of the literature was conducted using PubMed database from 1966 through 2015. Inclusion and exclusion criteria were applied. Outcomes assessed included total flap volumes, additional breast procedures to achieve intended breast volume, and complication rates. Results A total of 485 gracilis-type flaps were performed in 335 patients. V-TUG flaps provided the largest mean flap weights and did not require additional lipofilling or implant placement, whereas the majority of TUG flaps (50.6%) required additional fat grafting or implant placements. All flap types demonstrated a low incidence of donor-site morbidity. Overall flap loss rate was low; TUG flaps reported 2.3% total and 2.0% partial flap losses, while V-TUG and LGM flaps reported no flap losses. Conclusion This review found V-TUG yielded highest mean flap weights and did not require additional breast augmentation procedures as compared with the TUG. Also, the V-TUG was a safer donor-site option with fewer flap and donor-site morbidities.

Periosteal cells compared with autologous cancellous bone in lumbar segmental fusion

2008 ◽  
Vol 8 (6) ◽  
pp. 536-543 ◽  
Author(s):  
Michael Putzier ◽  
Patrick Strube ◽  
Julia Funk ◽  
Christian Gross ◽  
Carsten Perka
Keyword(s):  
Cancellous Bone ◽  
Lumbar Fusion ◽  
Donor Site ◽  
Index Patient ◽  
Donor Site Morbidity ◽  
Osteogenic Potential ◽  
Flexion Extension ◽  
Periosteal Cells ◽  
Group 2 ◽  
Group 1

Object Despite modern stabilization techniques and the use of autologous cancellous bone, bone consolidation does not occur in 10–15% of spinal fusion operations. There is also considerable donor site morbidity. Therefore, there is a definite need for material that has a larger measure of osteoinductivity, osteoconductivity, and osteogenic potential. Methods In this study, 24 patients with degenerative spinal disease underwent single-level circumferential lumbar fusion. The patients were randomly placed in 2 groups, each with different cage filling (Group 1, autologous iliac crest cancellous bone; Group 2, autologous periosteal cells in a fibrin/polyglactin-poly-p-dioxanone fleece). After 3, 6, 9, and 12 months, the patients underwent clinical (Oswestry Disability Index, patient satisfaction, willingness to undergo the operation again, visual analog scale for pain) and radiological (plain and flexion/extension radiographic and thin-layer computed tomography [CT]) examinations. Results The 6-month CT scans and 9-month radiographs obtained in Group 2 patients showed a significantly higher rate of fusion than those in Group 1 patients. Aside from this, there were no further significant differences. After 12 months, radiographic results showed a fusion rate of 80% in Group 1 and 90% in Group 2. No implant- or transplant-related complications were observed. Conclusions The use of autologous periosteal cells on carrier material with osteoinductive and osteoconductive properties showed comparable results with autologous cancellous bone and better results with regard to consolidation at 6–9 months postoperatively. The shorter consolidation time, as well as lower donor site morbidity, justifies the clinical use and further development of this tissue-engineering strategy.

Breast Reconstruction After Resection of Bilateral Giant Phyllodes Tumors: Two Separate Deep Inferior Epigastric Perforator Flaps From One Donor Site

2020 ◽  
Vol 20 (2) ◽  
pp. e188-e191
Author(s):  
Chin-Wen Tu ◽  
Chien-Liang Fang ◽  
Chong-Bin Tsai ◽  
Chin-Hao Hsu ◽  
Chih-Hsuan Changchien ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Donor Site ◽  
Perforator Flaps ◽  
Phyllodes Tumors ◽  
Deep Inferior Epigastric Perforator

scholarly journals Evaluation of Gingival Microleakage in Class II Composite Restorations with Different Lining Techniques: An In Vitro Study

Scientifica ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Vedavathi Bore Gowda ◽  
B. V. Sreenivasa Murthy ◽  
Swaroop Hegde ◽  
Swapna Devarasanahalli Venkataramanaswamy ◽  
Veena Suresh Pai ◽  
...  
Keyword(s):  
Study Groups ◽  
Class Ii ◽  
Composite Liner ◽  
Flowable Composite ◽  
Composite Restorations ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. To compare the microleakage in class II composite restorations without a liner/with resin modified glass ionomer and flowable composite liner.Method. Forty standardized MO cavities were prepared on human permanent mandibular molars extracted for periodontal reasons and then divided into 4 groups of ten specimens. The cavity preparations were etched, rinsed, blot dried, and light cured and Adper Single Bond 2 is applied. Group 1 is restored with Filtek P60 packable composite in 2 mm oblique increments. Group 2 is precure group where 1 mm Filtek Z350 flowable liner is applied and light cured for 20 sec. Group 3 is the same as Group 2, but the liner was cocured with packable composite. In Group 4, 1 mm RMGIC, Fuji Lining LC is applied and cured for 20 sec. All the teeth were restored as in Group 1. The specimens were coated with nail varnish leaving 1 mm around the restoration, subjected to thermocycling, basic fuchsin dye penetration, sectioned mesiodistally, and observed under a stereomicroscope.Results. The mean leakage scores of the individual study groups were Group 1 (33.40), Group 2 (7.85), Group 3 (16.40), and Group 4 (24.35). Group 1 without a liner showed maximum leakage. Flowable composite liner precured was the best.

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

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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