• Archives of Reconstructive Microsurgery
• /
• v.21 no.1
• /
• pp.8-13
• /
• 2012

Purpose: Purpose: The free deep inferior epigastric artery perforator (DIEP) flap is a popular option for autologous breast reconstruction. However, the anatomy of the deep inferior epigastric artery(DIEA) may vary from one individual to another. Unexpected vascular anomaly can confuse the surgeon and affects on the safety of the free DIEP flap. Materials and Methods: Thirty five consecutive patients who underwent free DIEP/TRAM flap for immediate breast reconstruction between Mar. 2010 and Oct. 2010 were enrolled in this study. Computed tomography angiography (CT angiography) of abdomen was evaluated part of our standard preoperative assessment: atypical patterns of DIEA/DIEP were evaluated by preoperative CT angiography and compared with intraoperative finding. Results: Atypical patterns of DIEA/DIEP which may affect preoperative planning were noted as the following: Circummusclar/subfascial DIEA (n=1), DIEA running underneath rectus muscle (n=8), septocutaneous perforator (n=3), peritoneo-cutaneous perforator (n=1), a large branch going into peritoneum (n=1), and very early division and muscle penetration of DIEA (n=1). Conclusion: Atypical DIEA/DIEP that might change the operation plan is not rare, so the individualized planning based on the preoperative CT angiography is recommended. Preoperative CT angiography could help to select reliable and easy-to-dissect perforator in free DIEP/TRAM breast reconstruction.

• Archives of Reconstructive Microsurgery
• /
• v.11 no.2
• /
• pp.141-145
• /
• 2002

Rectus abdominis muscle free flap is widely used for breast reconstruction and soft tissue defect in lower leg but donor-site morbidities such as abdominal wall weakness, hernia, bulging are troublesome. Recently, to minimize donor-site morbidity, there has been a surge in interest in deep inferior epigastric perforator(DIEP) free flap preserving the anatomy of rectus abdominis muscle, fascia, and motor nerve. Between August of 1995 and September of 2002, topographic investigation of DIEP was performed during the elevation of 97 cases of TRAM free flap and 5 cases of DIEP free flap. There were 84 cases of breast reconstructions, 12 cases of lower leg reconstructions, and 6 cases of head and neck reconstruction. We could observe total 10 to 12 perforators on each rectus abdominis muscle below umbilicus. Among these, the numbers of large perforators(>1.5mm of diameter) were mean 2.1 in lateral half of rectus abdominis muscle, mean 1.2 in medial half, and mean 0.5 in linea alba and paramedian. DIEP free flap provides ample amount of well vascularized soft tissue without inclusion of any rectus abdominis muscle and fascia and minimizes donor-site morbidity. One perforator with significant flow can perfuse the whole flap. For large flap, a perforator of the medial row provides better perfusion to zone-4 than one of lateral row and, if diameter of perforator is small, $2{\sim}3$ perforators can be used. According to the condition of recipient-site, thin flap can be harvested. As DIEP free flap has many advantage, perforator topography will be useful in increasing clinical usage of DIEP free flap.

• Archives of Plastic Surgery
• /
• v.37 no.4
• /
• pp.409-414
• /
• 2010

Purpose: Poland's syndrome encompasses a constellation of congenital chest wall, breast, and upper extremity deformities. We would like to present several techniques, which may be combined if necessary, used to treat the forms involving both the breast and chest wall according to the degree of deformity. Methods: In a retrospective series of 9 patients (3 men and 6 women), we report our experience with reconstructing breast and chest contour deformities associated with Poland syndrome. We recorded their age, gender, the surgical techniques, and the grade in Poland's syndrome according to the classification of Foucras. Results: The breast and chest wall deformities associated with Poland syndrome can be treated in individualized fashion according to the classification of Foucras. In case of 3 male patients with gradeI, II, the latissimus dorsi muscle pedicled flap improved the chest contour deformity. 3 female patients with grade II underwent the latissimus dorsi muscle pedicled flap with breast implant. 2 female patients with gradeIunderwent breast reconstruction with breast implant and fat injection each other. One female patient with severe chest wall deformity (grade III) underwent breast reconstruction using the free TRAM flap. All patients were satisfied with the results without specific complications. Conclusion: The Individualized correction for this syndrome according to the degree of patient's deformity and preference made the overall satisfaction of the patients high.

• Archives of Reconstructive Microsurgery
• /
• v.17 no.2
• /
• pp.94-100
• /
• 2008

In the past decade, there has been increasing breast reconstructions after mastectomy, and the abdomen has been the gold standard for donor site. TRAM (transverse rectus abdominis myocutaneous), MSTRAM (muscle sparing transverse rectus abdominis myocutaneous), DIEP (deep inferior epigastric artery perforator), SIEA (superficial inferior epigastric artery) flap has been widely used nowadays. Among them, DIEP free flap spares the whole rectus abdominis muscle and anterior rectus sheath resulting in decreased donor site morbidity. Between March of 2006 and February of 2008, six patients had undergone immediate breast reconstructions using DIEP free flap. The mean age of patients was 48.5 years. All patients had unilateral breast reconstructions. We dissected two perforators which were included in the unilateral pedicle. Thoracodorsal artery and its venae comitantes were chosen as recipient vessels. For venous anastomosis, we used the GEM Microvascular Anastomotic Coupler System (Synovis Micro Companies Alliance, Inc., Birmingham, Ala.) in four cases. All flaps were survived completely except one who showed fatty abdomen in old age. She showed repetitive vascular spasm intraoperatively. None of the patients had abdominal hernia, bulge or weakness. We believe that DIEP free flap provides a reliable method for autologous breast reconstruction if the patients are selected appropriately and performed by a skillful surgeon.

• Archives of Plastic Surgery
• /
• v.34 no.5
• /
• pp.617-621
• /
• 2007

Purpose: With the necessity of comprehensive care for the breast cancer patients, Breast Care Center of our hospital started to work in March 2004. This study examined the 3-year execution of Breast Care Center. The role of Breast Care Center was evaluated in aspect of clinical activities in quality and quantity. Methods: A retrospective review was carried out from 2001 to 2007 with breast cancer patients. The number and type of breast cancer surgery and breast reconstruction procedure were compared before and after Breast Care Center's foundation. Time required for the diagnosis and treatment was also compared. Regression analysis and T-test were used to identify the statistical significance. Results: The number of breast cancer surgery did not statistically increase compared with progressive increase of breast cancer. QUART(quadrantectomy, axillary dissection, radiotherapy) procedure statistically significantly increased and MRM(Modified Radical Mastectomy) procedure decreased for breast cancer surgery after foundation of Breast Care Center. The number of breast reconstruction procedures statistically significantly increased. The number of immediate TRAM free flap (Transverse Rectus Abdominal muscle free flap) procedures has grown 3.8 times after foundation of Breast Care Center. The time required for diagnosis and treatment was also shortened. Conclusion: After foundation of Breast Care Center, the number of breast reconstruction surgery increased, while the counselling time in breast reconstruction was reduced. Breast Care Center provided a prompt and comprehensive care to the breast cancer patients through the multidisciplinary therapeutic approaches.

• Archives of Plastic Surgery
• /
• v.47 no.5
• /
• pp.428-434
• /
• 2020

Background Three-dimensional (3D) model printing improves visualization of anatomical structures in space compared to two-dimensional (2D) data and creates an exact model of the surgical site that can be used for reference during surgery. There is limited evidence on the effects of using 3D models in microsurgical reconstruction on improving clinical outcomes. Methods A retrospective review of patients undergoing reconstructive breast microsurgery procedures from 2017 to 2019 who received computed tomography angiography (CTA) scans only or with 3D models for preoperative surgical planning were performed. Preoperative decision-making to undergo a deep inferior epigastric perforator (DIEP) versus muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flap, as well as whether the decision changed during flap harvest and postoperative complications were tracked based on the preoperative imaging used. In addition, we describe three example cases showing direct application of 3D mold as an accurate model to guide intraoperative dissection in complex microsurgical reconstruction. Results Fifty-eight abdominal-based breast free-flaps performed using conventional CTA were compared with a matched cohort of 58 breast free-flaps performed with 3D model print. There was no flap loss in either group. There was a significant reduction in flap harvest time with use of 3D model (CTA vs. 3D, 117.7±14.2 minutes vs. 109.8±11.6 minutes; P=0.001). In addition, there was no change in preoperative decision on type of flap harvested in all cases in 3D print group (0%), compared with 24.1% change in conventional CTA group. Conclusions Use of 3D print model improves accuracy of preoperative planning and reduces flap harvest time with similar postoperative complications in complex microsurgical reconstruction.