• Title/Summary/Keyword: Perforator

Search Result 273, Processing Time 0.035 seconds

Autologous Microvascular Breast Reconstruction

  • Healy, Claragh;Ramakrishnan, Venkat
    • Archives of Plastic Surgery
    • /
    • v.40 no.1
    • /
    • pp.3-10
    • /
    • 2013
  • Autologous microvascular breast reconstruction is widely accepted as a key component of breast cancer treatment. There are two basic donor sites; the anterior abdominal wall and the thigh/buttock region. Each of these regions provides for a number of flaps that are successfully utilised in breast reconstruction. Refinement of surgical technique and the drive towards minimising donor site morbidity whilst maximising flap vascularity in breast reconstruction has seen an evolution towards perforator based flap reconstructions, however myocutaneous flaps are still commonly practiced. We review herein the current methods of autologous microvascular breast reconstruction.

Trends and Innovations in Autologous Breast Reconstruction

  • Nicole E. Speck;Vendela Grufman;Jian Farhadi
    • Archives of Plastic Surgery
    • /
    • v.50 no.3
    • /
    • pp.240-247
    • /
    • 2023
  • More than 40 years have passed since the description of the first "free abdominoplasty flap" for breast reconstruction by Holmström. In the meantime, surgical advances and technological innovations have resulted in the widespread adoption of autologous breast reconstruction to recreate the female breast after mastectomy. While concepts and techniques are continuing to evolve, maintaining an overview is challenging. This article provides a review of current trends and recent innovations in autologous breast reconstruction.

Regional Analysis of Soft Tissue Thickness on Korean Buttocks and Application to Fasciocutaneous Flap Design

  • Kim, Do Yup;Choi, Hyun Nam;Park, Jin Hyung;Kim, Sin Rak;Kim, Hyun;Han, Yea Sik
    • Archives of Plastic Surgery
    • /
    • v.41 no.2
    • /
    • pp.133-139
    • /
    • 2014
  • Background Various shapes and designs of the gluteal artery perforator flap have been used for treating sacral pressure sores and reconstructing breasts. To establish the ideal fasciocutaneous flap design for use in the gluteal area, the soft tissue thickness distribution was measured. Methods Twenty-one buttocks of adult Korean cadavers were analyzed through rectangular subfascial dissection. Each buttock was divided horizontally into 10 sections and vertically into 10 sections, and then, the thickness at the corners of the sections was measured. For the sake of comparison and statistical verification with living bodies, computed tomography (CT) images of 120 buttocks of patients were randomly selected. Five horizontal sections and 4 vertical sections were made, and the thickness at each corner was recorded. Results According to the dissection and the CT images, the area with the thinnest soft tissues in the buttock was around the posterior superior iliac spine, close to the sacral area. The thickest area was the superolateral area of the buttock, which was 3.24 times and 2.15 times thicker than the thinnest area in the studies on cadaver anatomy and the CT images, respectively. Conclusions The thickness of the soft tissues in the buttocks differed by area. The superolateral area had the thickest soft tissues, and the superomedial area had the thinnest. This study includes information on the distribution of the thickness of the gluteal soft tissues of Koreans. The outcome of this study may contribute to the design of effective local flaps for pressure sore reconstruction and free flaps for breast reconstruction.

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

  • Yu, Ya-han;Ghorra, Dina;Bojanic, Christine;Aria, Oti N.;MacLennan, Louise;Malata, Charles M.
    • Archives of Plastic Surgery
    • /
    • v.47 no.5
    • /
    • pp.473-477
    • /
    • 2020
  • 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.

Reduction of Formaldehyde Emission from Particleboardsby Bio-Scavengers

  • Eom, Young-Geun;Kim, Jong-Sung;Kim, Sumin;Kim, Jin-A;Kim, Hyun-Joong
    • Journal of the Korean Wood Science and Technology
    • /
    • v.34 no.5
    • /
    • pp.29-41
    • /
    • 2006
  • This study was to investigate the effect of adding additive as tannin, rice husk and charcoal, for reducing the formaldehyde emission level, on the adhesion properties of urea-formaldehyde (UF) resin for particleboard. We controlled the hot-pressing time, temperature and pressure to determine the bonding strength and formaldehyde emission. Blends of various UF resin/additives (tannin, rice husk and charcoal) compositions were prepared. To determine and compare the effect of additives (tannin, rice husk and charcoal) content, 0, 5, 10 and 15%, by weight of UF resin, were used. $NH_4Cl$ as hardener added. To determine the level of formaldehyde emission, we used the desiccator, perforator and 20 L-small chamber method. The formaldehyde emission level decreased with increased additions of additive (except rice husk). Also, increased hot-pressing time decreased formaldehyde emission level. At a charcoal replacement ratio of only 15%, the formaldehyde emission level is under F ✩ ✩ ✩ ✩ grade (emit < $0.3mg/{\ell}$). Curing of the high tannin additive content in this adhesive system indicated that the bonding strength increased. But, in the case of rice husk and charcoal, the bonding strength was much lower due to the inorganic substance. Furthermore, rice husk was poor in bonding strength as well as formaldehyde emission than tannin and charcoal.

Surgical implications of anatomical variation in anterolateral thigh flaps for the reconstruction of oral and maxillofacial soft tissue defects: focus on perforators and pedicles

  • Kim, Ji-Wan;Kim, Dong-Young;Ahn, Kang-Min;Lee, Jee-Ho
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
    • /
    • v.42 no.5
    • /
    • pp.265-270
    • /
    • 2016
  • Objectives: To gain information on anatomical variation in anterolateral thigh (ALT) flaps in a series of clinical cases, with special focus on perforators and pedicles, for potential use in reconstruction of oral and maxillofacial soft tissue defects. Materials and Methods: Eight patients who underwent microvascular reconstructive surgery with ALT free flaps after ablative surgery for oral cancer were included. The number of perforators included in cutaneous flaps, location of perforators (septocutaneous or musculocutaneous), and the course of vascular pedicles were intraoperatively investigated. Results: Four cases with a single perforator and four cases with multiple perforators were included in the ALT flap designed along the line from anterior superior iliac spine to patella. Three cases had perforators running the septum between the vastus lateralis and rectus femoris muscle (septocutaneous type), and five cases had perforators running in the vastus lateralis muscle (musculocutaneous type). Regarding the course of vascular pedicles, five cases were derived from the descending branch of the lateral circumflex femoral artery (type I), and three cases were from the transverse branch (type II). Conclusion: Anatomical variation affecting the distribution of perforators and the course of pedicles might prevent use of an ALT free flap in various reconstruction cases. However, these issues can be overcome with an understanding of anatomical variation and meticulous surgical dissection. ALT free flaps are considered reliable options for reconstruction of soft tissue defects of the oral and maxillofacial area.

A Case Report of Nail Bed Reconstruction with Digital Artery Perforator (DAP) Flap and Buccal Mucosal Graft (수지동맥천공지피판술과 볼점막 이식을 통한 조갑상 손상 치험 1례)

  • Lee, Yong-Woo;Kim, Youn-Hwan;Kim, Jeong-Tae
    • Archives of Plastic Surgery
    • /
    • v.38 no.1
    • /
    • pp.113-116
    • /
    • 2011
  • Purpose: Many fingertip injuries are associated with nail injury and it is hard to repair to original shape due to its unique characteristic. Mucosal graft is used for a defect of the nail bed injury. Hereby, we introduce a DAP flap and buccal mucosal graft, with which we could reduce the defect size of the injured fingertip and donor site morbidity at the same time, without any need for harvesting additional skin from other part of hand. Also, mucosal graft makes good cosmetic and functional outcome of nail. Methods: This method was performed in a 56-year-old man with fingertip injury on dorsal side of left thumb due to electrical saw. First, DAP flap was performed on the injured finger to reduce the size of the defect of fingertip and cover the bone exposure. Second, nail bed part of the DAP flap was de-epithelized and buccal mucosal graft was done from left side of intraoral cavity wall. Results: Flap and graft survived without any necrosis but some nail bed could not be covered with flap due to insufficient flap size. All wounds healed well and did not present any severe adversary symptoms. Conclusion: DAP flap with mucosal graft is an effective method that we can easily apply in reconstruction of fingertip injury. We suggest that the combination of the two procedures makes good functional and cosmetic outcome compared to the usual manner, especially in cases of nail bed injury without distal phalanx bone defect.

Scar Wars: Preferences in Breast Surgery

  • Joyce, Cormac W;Murphy, Siun;Murphy, Stephen;Kelly, Jack L;Morrison, Colin M
    • Archives of Plastic Surgery
    • /
    • v.42 no.5
    • /
    • pp.596-600
    • /
    • 2015
  • Background The uptake of breast reconstruction is ever increasing with procedures ranging from implant-based reconstructions to complex free tissue transfer. Little emphasis is placed on scarring when counseling patients yet they remain a significant source of morbidity and litigation. The aim of this study was to examine the scarring preferences of men and women in breast oncoplastic and reconstructive surgery. Methods Five hundred men and women were asked to fill out a four-page questionnaire in two large Irish centres. They were asked about their opinions on scarring post breast surgery and were also asked to rank the common scarring patterns in wide local excisions, oncoplastic procedures, breast reconstructions as well as donor sites. Results Fifty-eight percent of those surveyed did not feel scars were important post breast cancer surgery. 61% said that their partners' opinion of scars were important. The most preferred wide local excision scar was the lower lateral quadrant scar whilst the scars from the deep inferior epigastric artery perforator (DIEP) flap were most favoured. The superior gluteal artery perforator flap had the most preferred donor site while surprisingly, the DIEP had the least favourite donor site. Conclusions Scars are often overlooked when planning breast surgery yet the extent and position of the scar needs to be outlined to patients and it should play an important role in selecting a breast reconstruction option. This study highlights the need for further evaluation of patients' opinions regarding scar patterns.