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

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.

Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap

1999 ◽  
Vol 52 (4) ◽  
pp. 276-279 ◽  
Author(s):  
Z.M. Arnez ◽  
U. Khan ◽  
D. Pogorelec ◽  
F. Planinsek
Keyword(s):  
Breast Reconstruction ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Siea Flap

Clinical Decision Making Using CTA in Conjoined, Bipedicled DIEP and SIEA for Unilateral Breast Reconstruction

2019 ◽  
Vol 36 (04) ◽  
pp. 241-246 ◽  
Author(s):  
Min-Jeong Cho ◽  
Nicholas T. Haddock ◽  
Sumeet S. Teotia
Keyword(s):  
Breast Reconstruction ◽  
Clinical Decision Making ◽  
Free Flaps ◽  
Clinical Decision ◽  
Computed Tomographic Angiography ◽  
Computed Tomographic ◽  
Patient Demographics ◽  
Epigastric Artery ◽  
Deep Inferior Epigastric Perforator ◽  
Tomographic Angiography

Abstract Background Using a hemi-abdominal flap for unilateral breast reconstruction in patients may not be ideal due to paucity of abdominal tissue, presence of a lower abdominal midline scar, or a larger and/or ptotic contralateral native breast. Several algorithms exist to make these flaps successful, but all of them require an anastomosis sequence ultimately. In this study, we present our experience with the use of imaging to predict flap dominance and anastomosis sequence to make them consistently successful. Methods Seventy-five consecutive conjoined, bipedicled abdominal composite free flaps for unilateral breast reconstruction were performed. Preoperative computed tomographic angiography (CTA) was obtained to depict the pattern of perforators, flap dominance, and feasibility for intraflap anastomosis. Patient demographics, type/weights of flaps, number of anastomoses, location of perforators, length/type of pedicles, and flap-related complications were reviewed. Results Seventy-five patients underwent composite deep inferior epigastric perforator (DIEP) and/or superficial inferior epigastric artery (SIEA) flaps. There were 62 DIEP-DIEP flaps, 11 DIEP-SIEA flaps, and two SIEA-SIEA flaps. The mean age was 57 years with an average body mass index of 27 kg/m2 and flap weight of 1,054 g. Thirty-one patients underwent intraflap (41%) and 44 patients underwent crania/caudal anastomoses (59%). In comparison to bilateral DIEPs, the total number of perforators was significantly lower (2.9 vs. 3.8), and fat necrosis rate was lower (2.7 vs. 14.4%) as well. Conclusion Guided by preoperative CTA imaging, we recommend the consistent use of these conjoined, bipedicled hemi-abdominal flaps for unilateral breast reconstruction, primarily those with delayed reconstruction and radiation deficits. Preoperative CTA imaging is crucial in directing perforator dissection to maximize overlapping perfusion zones and guide in performing anastomoses.

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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