• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.15-19
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• 1998

Microsurgical free-tissue transfer has allowed surgeons to salvage injured limbs but choosing appropriate healthy recipient vessels has proved to be a difficult problem. Retrograde flow flaps are established in island flaps. Retrograde flow anastomosis could prevent the possible kinking and twisting of the arterial anastomosis. By not interrupting the proximal blood flow to the fracture or soft tissue defect site, the compromise of fracture or wound healing might be prevented. We wished to estabilish an animal model in rat for a retrograde arterial flow based free flap. Nembutal-anesthetized male rats; weighing 250 to 300 gm, were used. The femoral artery and common carotid artery were exposed and divided. The systemic and retrograde arterial pressure were quantified by utilizing a parallel tubing system connected with peripheral arterial line. In this study, the retrograde flow was not pulsatile and the retrograde arterial pressure was 64-65mmHg, with a mean arterial pressure of 106-109mmHg. An epigastiic skin flap, measuring $3{\times}3cm$, was raised with its vascular pedicle. The epigastric free flap was transfered in the same rat from femoral vessels to carotid vessels in end to end fashion. We anastomosed the donor arteries to the distal parts of the divided recipient arteries and the donor veins to the proximal parts of the recipient veins. Twelve experiments were performed and the transplantations succeeded in 75 percent of them. In the remaining 25 percent, the experiments failed due to thrombosis at the site of anastpmosis, or other causes. This animal model represents an excellent example of retrograde arterial flow free flap transfer that is reliable.

• Archives of Plastic Surgery
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• v.50 no.2
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• pp.153-155
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• 2023

The vascular anatomy of the deep inferior epigastric artery perforator (DIEP) flap has been well studied in the planning for autologous breast reconstruction. Preoperative imaging with computed tomography angiography (CTA) provides accurate assessment of this vascular anatomy, which varies widely across patients. Several papers to date have described their encounter with an anomalous "epiperitoneal" or "peritoneo-cutaneous" perforator during flap harvest, a perforator that pierces the posterior rectus sheath from a peritoneal origin, to traverse rectus abdominis and supply the DIEP flap integument. In the course of over 3,000 CTA assessments of the vascular anatomy of the abdominal wall, we have encountered dominant peritoneo-cutaneous perforators in 1% of cases, and smaller perforators seen in many more cases, approaching 5% of cases. With increasing sensitivity of imaging, we also describe a unique case of multiple large bilateral peritoneo-cutaneous perforators, and present these findings in the context of DIEP flap harvest. It is critical to recognize these peritoneo-cutaneous perforators preoperatively to avoid mistaking them for a DIEP during the raising of a DIEP flap. The routine use of preoperative CTA enables the safe identification of individual vascular anatomy, including significant peritoneo-cutaneous perforators.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.577-582
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• 2010

Purpose: When reconstruction for patients who have the large contralateral breast or a following large defect after mastectomy is required, conventional pedicled TRAM flap shows the unpredictable occurrence of fat necrosis and skin flap loss in a relatively high percentage due to insufficient blood supply. In an effort to obtain more stable TRAM flap blood circulation, we have performed a supercharged technique using deep inferior epigastric perforators (DIEP) with conventional pedicled TRAM flap. Methods: From September of 2006 to December of 2008, Fourteen supercharged TRAM flap were performed for breast reconstruction after modified radical mastectomy. The contralateral DIEP was anastomosed to the internal mammary vessels in contralateral pedicled TRAM flap or thoracodorsal vessels in ipsilateral pedicled TRAM flap. Nutrient vessels were selected by Multi-Detector Computed tomography (MD-CT) modalities. For the nutrient vessel, we used deep inferior epigastric vessels (DIEV) of the ipsilateral side in 8 patients, DIEV of the contralateral side in 6 patients. In addition, for the recipient vessel, we used thoracodorsal vessels in 8 patients, internal mammary vessels in 5 patients, intercostals artery perforators in 1 patient. Results: The mean age was 46.8 years and the average follow-up interval was 14 months. There were 11 immediate and 3 delayed breast reconstructions. Fat necrosis incidence rate in supercharged TRAM group was lower than in conventional TRAM flap group. There were no differences of the incidences of abdominal hernia in both groups. Conclusion: The supercharged TRAM flap produces an improvement in vascularity that permits use of all four zones of the flap. The breast reconstruction with supercharged technique is reliable and valuable methods which provide sufficient soft tissue from abdomen without significant complications.

• Archives of Hand and Microsurgery
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• v.23 no.4
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• pp.281-289
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• 2018

Purpose: Preoperative surgical planning utilizing computed tomography angiography (CTA) has now become a routine in many practices. We analyzed the course of the deep inferior epigastric artery (DIEA) and its perforators (DIEP) that would either facilitate or hinder flap dissection based on CTA to aid surgical planning. Methods: The 115 consecutive patients who underwent abdominally based free flap breast reconstruction were enrolled in this prospective study. DIEA/P courses were categorized mainly according to their intramuscular courses and their incidences were investigated. Results: A total of 425 perforators were identified preoperatively on the CTA, with an average number of 3.7 distinctly visualized in the entire flap territory. Eighty-nine perforators (20.9%) had a favorable (less than 1 cm intramuscular course) pattern, namely long submuscular (34.8% of the patients), long subfascial (15.6%), and total circummuscular (13.9%). Overall 56.5% of the patients had at least one favorable DIEA/P. On the other hand, absence of DIEA and absence of adequate (>1 mm) DIEP was reported in 3 and 8 hemiabdomen. Conclusion: Preoperative CTA evaluation of DIEA/P can be used to identify favorable as well as unfavorable courses for dissection to aid surgical planning.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.737-741
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• 2006

Purpose: This study was to evaluate the expression pattern of CD 18(leukocyte adhesion glycoprotein) in ischemia-reperfusion injury of TRAM flap of rats. Through this study, we can obtain more information about ischemia-reperfusion injury. We want to develop specific medicine to improve the survival rate of TRAM flap in the future. Methods: A TRAM flap supplied by a single pedicle superior epigastric artery and vein was elevated on 60 Sprauge-Dawley rats. The rats were divide into 6 groups (each group n=10); Group O: sham, no ischemia-reperfusion injury, Group I: 2 hour reperfusion after 4 hour ischemia, Group II: 4 hour reperfusion after 4 hour ischemia, Group III: 8 hour reperfusion after 4 hour ischemia, Group IV: 12 hour reperfusion after 4 hour ischemia, and Group V: 24 hour reperfusion after 4 hour ischemia. This study consisted of gross examination for flap survival and flow cytometry study of CD18 on neutrophils. Results: The gross measurement of the flap showed different survival rate in group I(71%), II(68%), III(37%), IV(34%) and V(34%). All experimental groups showed an increase in the expression of CD18 compared to group O. The expression of CD18 was rapidly increased in ascending order in group I, II and III. But, the expression of CD18 was maintained in group IV and V. Conclusion: The results can be implemented in the study to develop drugs which are capable of reducing ischemia-reperfusion injury in microsurgical breast reconstruction.

• Archives of Plastic Surgery
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• v.44 no.2
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• pp.109-116
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• 2017

Background The effect of liposuction on the perforators of the lower abdominal wall has been investigated in several studies. There are controversial results in the literature that have primarily demonstrated the number and patency of the perforators. The aim of this study was to determine the effect of liposuction on the perfusion of perforator-based abdominal flaps using a combined laser-Doppler spectrophotometer (O2C, Oxygen to See, LEA Medizintechnik). Methods Nine female patients undergoing classical abdominoplasty were included in the study. Perforators and the perfusion zones of the deep inferior epigastric artery flap were marked on the patient's abdominal wall. Flap perfusion was quantitatively assessed by measuring blood flow, velocity, capillary oxygen saturation, and relative amount of hemoglobin for each zone preoperatively, after tumescent solution infiltration, following elevation of the flap on a single perforator, and after deep and superficial liposuction, respectively. Results The measurements taken after elevation of the flap were not significantly different than measurements taken after the liposuction procedures. Conclusions The liposuction procedure does not significantly alter the perfusion of perforator-based abdominal flaps in the early period. The abdominal tissue discarded in a classic abdominoplasty operation can be raised as a perforator flap and has been demonstrated to be a unique model for clinical research.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.139-143
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• 2014

Spontaneous intramuscular hematoma of the abdominal wall is a rare condition characterized by acute abdominal pain. It is often misdiagnosed as a surgical condition. It used to be associated with risk factors such as coughing, pregnancy, and anticoagulant therapy. Most cases of abdominal wall hematomas were rectus sheath hematomas caused by the rupture of either the superior or inferior epigastric artery, but spontaneous internal oblique hematoma was extremely rare. In this report, we present a case of spontaneous internal oblique hematoma in a 69-year-old man with non-dialysis chronic kidney disease who was taking cilostazol. The patient complained of abrupt abdominal pain with a painful palpable lateral abdominal mass while sleeping. The abdominal computed tomography showed an 8 cm-sized mass in the patient's left internal oblique muscle. The administration of cilostazol was immediately stopped, and the intramuscular hematoma of the lateral oblique muscle disappeared with conservative management.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.29 no.6
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• pp.421-429
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• 2003

Purpose : Neoadjuvant chemotherapy is commonly used to treat cancer patients as adjunct treatment, but if the microvascular tissue transfer is performed simulataneously with cancer resection surgery, the induction chemotherapy might affect the survival rate of vascularized free flap. Our study will focus on the effect of induction chemotherapy on the free flaps which were made on white rat abdomen after injection of 5-FU. Materials and Methods: The experimental rat groups were divided into three groups (total 24 rats) as a normal control group, 24 hrs group after 5-FU injection, 3 days group after 5-FU injection. Inferior abdominal island flaps of 8 Sprague Dawley rats on each group were made and immediately were induced into an ischemic state by clamping the supplying inferior epigastric artery and vein with microvascular clamp for a hour to induce a similiar free flap circumstance, then the inferior abdominal skin flaps were reperfused by releasing the clamps. The flaps on abdomen were repositioned and sutured. The experimental data for flap survival rate was collected by digital photo taking, analysed by computer image program to compare with the flap luminosity. The rats were sacrificed at 3 days, 5 days, 7 days after flap preparation and specimens of the flap were taken and stained with H-E staining. The microscopic finding was made under magnification of 200 and 400. Results: 1. Gross findings on each groups showed the healing condition was good as following sequences; normal, 24 hrs group after chemotherapy, 3 days group after chemotherpy. 2. The values of flap luminosity for evaluation of flap survival rate also showed the same sequences as gross findings of healing state. 3. The microscopic findings of epidermis necrosis, inflammation state, dermis fibrosis, vessel change, fatty tissue layer thinning were compared with each group. The 3 days group after chemotherapy showed remarkably poor healing condition compared to other groups. Conclusion: Chemotherapy agents affected the healing process of free flap, but healing condition was recovered spontaneously as post-injection periods passed out. In opposite to our expectation, 3 days group showed the bad flap condition in comparing with 24 hours group which was considered as immatured body circulation state of chemotherapy agent. It showed that 3 weeks in human being after chemotherapy was not proper as timing of microvascular tissue transfer if 3 days group in rat was considered as same healing period of 3 weeks in human being. More delayed healing timing than 3 weeks might be required in clinical application of free tissue transfer.