Publications by authors named "Lanhua Mu"

19 Publications

  • Page 1 of 1

A prospective study of breast dynamic morphological changes after dual-plane augmentation mammaplasty with 3D scanning technique.

PLoS One 2014 26;9(3):e93010. Epub 2014 Mar 26.

Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China.

Background: The dual-plane technique has been widely used in augmentation mammaplasty procedures. However, there are some concerns about aesthetic contour maintenance for long time after muscle releasing. This study aims to track and analyze breast dynamic morphological changes after dual-plane breast augmentation with three-dimensional (3D) scanning technique.

Methods: Thirteen dual-plane anatomic implant augmentation patients underwent 3D scanning preoperatively (pre-OP) and postoperatively in four time points (1 month: post-1M, 3 months: post-3M, 6 months: post-6M and 12 months: post-12M). The linear distance, breast projection, nipple position, breast volume and breast surface area were measured and analyzed on the 3D models over time.

Results: Compared with post-12M, no significant differences were found in distances of nipple to midline, nipple to inframammary fold and sternal notch to the level of inframammary fold after 6 months in both straight-line distance and its projection on surface. The distances between sternal notch and nipple had no significant difference after post-1M. Breast volume changes had no significant difference after post-3M. The volume and area percentage of upper pole decreased while the lower pole's increased gradually. The surface showed no significant changes after post-1M. The changes of breast projection had no significance after post-1M either. The nipple moved 1.0±0.6 cm laterally (X axis), 0.6±0.7 cm upward( Y axis) and 2.3±1.1 cm anteriorly (Z axis) at post-12M, and the differences were not significant after post-1M.

Conclusions: 3D scanning technique provides an objective and effective way to evaluate breast morphological changes after augmentation mammaplasty over time. Dual-plane augmentation optimizes breast shape especially in the lower pole and maintains stable aesthetic outcome during the 12 months follow-up. Most of the contour changes and the interadaptation with the implant have completed 6 months after operation. Therefore, 6 months could be chosen as a relatively stable observing period in the assessment of postoperative outcomes of dual-plane breast augmentation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093010PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966867PMC
June 2015

Hemodynamic effect of different kinds of venous augmentation in a pig transmidline flap model of DIEP flap.

J Reconstr Microsurg 2013 Jul 13;29(6):379-86. Epub 2013 May 13.

Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Collage, Beijing, PR China.

Background: Venous augmentation enhances the viability of the deep inferior epigastric perforator (DIEP) flap. We compared the efficacy of three venous superdrainage procedures on survival area and hemodynamics of the DIEP flap model.

Methods: In 24 castrated Yorkshire pigs, a true abdominal perforator-based flap was created based on four perforators arising from the deep superior epigastric vessels. Three remaining venous tracts were alternated to represent different venous augmentations of the DIEP flap. Analyzed were flap perfusion, venous blood pressure, and venous blood gas. In control animals, all three supplemental veins were ligated; the ipsilateral superficial superior epigastric vein (SSEV) was retained in the IS (ipsilateral SSZV augmented) group, the contralateral SSEV in the CS (contralateral SSZV augmented) group and the contralateral deep superior epigastric vein (DSEV) in the CD (contralateral DSZV augmented) group. The flap was then returned to its bed, and animals sacrificed on the seventh day postoperatively. DIEP flap survival was then recorded.

Results: All four intraoperative parameters showed improved perfusion of the distal flap area under distal venous augmentation. Efficacy was CDSEV > CSSEV > ISSEV > none. Skin islands of the CD and CS groups survived completely. In the IS and control groups, 96.33 ± 3.16% and 84.00 ± 7.55% of skin islands survived, respectively. Test groups were statistically significantly different from the control group but not from each other.

Conclusions: Venous superdrainage effectively enhances DIEP flap survival. Benefit was relatively the same for all procedures. An additional venous route should be preserved with large or multiterritory flaps to improve venous congestion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0033-1343497DOI Listing
July 2013

A minimally invasive gradual traction technique for inverted nipple correction.

Aesthetic Plast Surg 2012 Oct 31;36(5):1151-4. Epub 2012 Aug 31.

Chinese Academy of Medical Sciences, Beijing, China.

Background: An inverted nipple affects not only the aesthetic appearance of the breast but also breastfeeding. Most surgical procedures can cause injury to normal lactiferous ducts and sensory dysfunction. The authors present a simple, safe, and minimally invasive technique for treating inverted nipples.

Methods: A distracter was made using the distal end of a 5- or 10-ml disposable syringe. The length was 1.3-1.5 cm, and pinholes with a diameter of 1 mm were punctured at 3, 6, 9, and 12 o'clock at the apex of the distracter. The inverted nipple was pulled out, and two steel wires with a diameter of 0.6 mm were crossed through the nipple base and fixed to the external distracter. After surgery, the wires were tightened once per month. According to the severity of the nipple inversion, the distracter was removed after 4-6 months of traction.

Results: This method was used to correct 604 inverted nipples of 310 patients. The follow-up period ranged from 6 months to 2 years. No complications associated with surgery such as infection, depigmentation, sensory disturbance, or nipple necrosis occurred. The great majority of the patients (95.8 %) were satisfied with the aesthetic results.

Conclusions: The described technique is minimally invasive, simple, safe, reliable, and low in cost. Satisfying aesthetic results can be achieved without destroying breastfeeding function or nipple sensation.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00266-012-9959-1DOI Listing
October 2012

Correction of chest wall depression in Poland's syndrome with flipped LDM flap.

J Plast Reconstr Aesthet Surg 2012 Nov 6;65(11):e311-2. Epub 2012 Jul 6.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjps.2012.06.009DOI Listing
November 2012

An innovative method for intraoperative shaping and positioning of the nipple-areola complex in reduction mammaplasty and mastopexy.

Aesthetic Plast Surg 2012 Aug 13;36(4):908-13. Epub 2012 Apr 13.

Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China.

Unlabelled: Issues of hypertrophic circumareolar scars and malpositioning or irregularity of the nipple-areola complex (NAC) are frequently associated with breast reduction or mastopexy techniques that rely on an ample excision of skin around the areola, either alone or associated with a vertical incision. To avoid such problems, many efforts have been made to improve the accuracy of preoperative marking for the future NAC. However, the correct design and position of the NAC may be difficult to achieve for the patient at the end of the procedure after closure of the skin incisions. This article describes a novel, simple, and effective method for intraoperative shaping and positioning of the NAC. The described method is based on using a specially designed surgical instrument to determine the best position, diameter, shape, and configuration of a new NAC. This study aimed to demonstrate the efficacy of this method to reduce the common complications of the periareolar region in reduction mammaplasty and mastopexy.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00266-012-9898-xDOI Listing
August 2012

Transmidline abdominal skin flap model in pig: refinements and advancements.

J Reconstr Microsurg 2012 Feb 13;28(2):111-8. Epub 2011 Oct 13.

Center of Breast Plastic and Reconstructive Surgery, Hospital of Plastic Surgery, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

Abdominal flaps have recently gained considerable popularity in breast reconstruction, and their importance and advantages have been widely accepted. Given the unreliability of the distal parts in these flaps and the advancement of microsurgery, many modifications and improvements have been made. To get a better understanding of these flaps, researchers have encouraged the search for a suitable flap model. The purpose of this study was to clarify the anatomical and physiological features of the transmidline abdominal flap model in pig. We included 16 white female Yorkshire pigs in this study. In six pigs, the vascular anatomy of the abdominal region was studied by multidetector row computed tomographic angiography and anatomic dissection. In the remaining 10 pigs, three kinds of transmidline abdominal flap models were established. The pigs were scanned on the abdominal flap to evaluate the perfusion zones after the true abdominal transmidline flap was created, and then they were sacrificed to determine the flap survival area 7 days after surgery. The results of the study were as follows. (1) The pig's deep inferior epigastric vessels were smaller than deep superior epigastric vessels both in length and diameters. (2) The deep superior epigastric artery always bifurcates into two groups; each group gives off five or six branches. (3) The superficial superior epigastric veins were present, while the superficial epigastric arteries were absent in all the animals included. (4) The linea alba abdominis was tough and lack of vascular structures. The average perfusion units were 197.0 ± 24.2, 103.2 ± 36.4, 138.8 ± 25.4, and 30.2 ± 11.8 from zone I to zone IV. All the flaps underwent partial necrosis. The flap survival area percentage was 85.9 ± 4.1%. The transmidline abdominal skin flap in pig is a reliable and true abdominal flap model for future physiological studies, especially the circulatory dynamics in transmidline abdominal flaps.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0031-1289162DOI Listing
February 2012

Repetitive arterial crisis of deep inferior epigastric perforator flap after mental stress: a case report.

J Reconstr Microsurg 2011 Jul 8;27(6):337-42. Epub 2011 Jun 8.

Center for Mammoplasty and Breast Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

The authors report a case of mental stress-induced repeatedly failing microsurgical flap. A 33-year-old female patient underwent a left breast reconstruction with deep inferior epigastric perforator flap. Repetitive arterial crisis occurred postoperatively, which eventually led to flap necrosis. In this case, there was clear correlation between the arterial crisis and mental factors. Mental stress may lead to arterial crisis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0031-1278711DOI Listing
July 2011

The efficacy of preoperative vascular mapping by MDCTA in selecting flap in abdominal flap breast reconstruction.

Breast J 2011 Mar-Apr;17(2):138-42. Epub 2011 Feb 7.

Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

Current methods of breast reconstruction using abdominal tissue include the transverse abdominal myocutaneous (TRAM) flap, deep inferior epigastric arterial perforator (DIEP) flap, superficial inferior epigastric arterial (SIEA) flap, and some other composite flaps. Because of the variant vascular anatomy in abdominal region, it is hard to choose an appropriate flap for a specific patient without accurate preoperative vascular mapping. This study was drawn to address the efficacy of preoperative vascular mapping by multidetector-row computed tomographic angiography (MDCTA) in selecting flap in abdominal flap breast reconstruction. A total of 34 breast reconstructions using abdominal flap from December 2006 to July 2009 were included. In all the patients included, MDCTA was performed preoperatively. Three indexes were obtained including choice of flaps, operation time, and flap complication rate. Then, these data were compared with the former data stored in the databank of our hospital from January 2004 to December 2006, before MDCTA was introduced in our center. Among the 34 patients, the flap selection was: SIEA flaps 11.8%, DIEP flaps 61.8%, TRAM flaps 11.8%, and bilateral flaps 14.7%. The correlate indexes from the data bank were as follows: SIEA flap 0; DIEP flaps 51.7%; TRAM flaps 32.8%; bilateral flaps 15.5%. p < 0.05 occurred between the comparison of SIEA, DIEP, and TRAM flap choice in the two groups. The operation time in the study group was as follows: SIEA flap (4.02 ± 0.46) hours, DIEP flap (6.23 ± 1.42) hours, TRAM flap (4.72 ± 1.53) hours, Bilateral flap (7.86 ± 1.16) hours; while the former correlate data were: DIEP (9.67 ± 1.74) hours, TRAM flap (6.64 ± 1.83) hours, bilateral flap (11.83 ± 1.35) (all the three comparison p < 0.05). The total flap complication rate was about 5.9% in the test group; while in the databank, it was 12.1% (p < 0.05). With the accurate mapping of vascular territory in abdomen by MDCTA, we could easily select a suitable abdominal flap for breast reconstruction, and we can also simplify the procedure to save operation time and make the process more safely.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1524-4741.2010.01048.xDOI Listing
July 2011

The role of three-dimensional scanning technique in evaluation of breast asymmetry in breast augmentation: a 100-case study.

Plast Reconstr Surg 2010 Dec;126(6):2125-2132

Beijing, People's Republic of China From the Department of Aesthetic and Plastic Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences.

Background: Three-dimensional scanning offers new opportunities to enable objective and quantitative analysis of the breast. The authors introduce an innovative method of performing a thorough analysis of breast asymmetry by means of three-dimensional scanning.

Methods: One hundred breast augmentation patients underwent preoperative three-dimensional scanning. The coordinate system was established and the three-dimensional breast model was analyzed using software. The discrepancies of nipple level, nipple to midline distance, inferior mammary fold level, breast width, breast projection, breast volume, and anterior chest wall projection were measured.

Results: The mean discrepancies of nipple level, nipple to midline distance, inferior mammary fold level, breast width, breast projection, and anterior chest wall projection were 4.9±3.7, 4.1±3.5, 4.7±3.5, 4.6±2.7, 5.4±4.1, and 4.4±2.9 mm, respectively. The mean discrepancy of breast volume was 48±42 ml. The incidence of significant asymmetry of nipple position was 72 percent. The incidence of significant asymmetry of the breast mound was 94 percent (patients with at least one parameter with significant asymmetry), and the incidence of asymmetric inferior mammary fold level, breast width, breast projection, and breast volume was 44, 46, 46, and 76 percent, respectively. The incidence of significant asymmetry of the anterior chest wall projection was 36 percent. None of the patients was completely free of asymmetry. Ninety-two percent had at least two parameters of asymmetry and 72 percent had at least three parameters of asymmetry.

Conclusions: A thorough evaluation of breast asymmetry can be carried out with the authors' innovative method. This study indicates that three-dimensional measurement of the breast will probably play an important role in implant selection to correct breast asymmetry.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PRS.0b013e3181f46ec6DOI Listing
December 2010

The relationship between the thickness of de-epithelialization and occurrence of sebaceous cysts at the incision site after mastopexy and reduction mammaplasty.

Ann Plast Surg 2010 Oct;65(4):389-90

Center for Mammoplasty and Breast Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

Periareolar sebaceous cysts at the incision site after mastopexy and reduction mammaplasty are very unpleasant complications that affect the surgical result and the degree of patient satisfaction. The author sought to investigate the cause and prevention of such sebaceous cysts. Sixty patients undergoing mastopexy or reduction mammaplasty were randomly divided into 2 groups. Periareolar de-epithelialization was performed to a depth of superficial layer of the dermis in group A and nearly the full thickness of the dermis in group B, and the incidence of sebaceous cysts was compared between these 2 groups. Patients were followed-up for 2 to 4 years. In group A, sebaceous cysts at the incision site were found in 4 patients (13.3%); however, no sebaceous cysts occurred in group B. Increasing the thickness of de-epithelialization appears to decrease the incidence of sebaceous cysts at the incision site.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SAP.0b013e3181d50e69DOI Listing
October 2010

A new experimental venous super-drained transmidline abdominal skin flap model in pig.

J Plast Reconstr Aesthet Surg 2010 Oct 23;63(10):e764-5. Epub 2010 Jun 23.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjps.2010.04.046DOI Listing
October 2010

Needing a large DIEAP flap for unilateral breast reconstruction: double-pedicle flap and unipedicle flap with additional venous discharge.

Microsurgery 2010 ;30(2):111-7

Department of Plastic Surgery, Catholic University of Sacred Hearth, Rome, Italy.

Background: In selected cases a four zone-deep inferior epigastric artery perfortor (DIEAP) flap is needed for unilateral breast reconstruction. It may happen in patients with a midline scar of the abdomen or with minimal abdominal tissue, as well as in case the recipient site needs a big amount of tissue for the breast reconstruction. The purpose of this paper is to describe two options: to raise an unipedicle DIEAP flap including large size medially located perforator/s with an additional venous outflow, or to raise a double-pedicle DIEAP flap.

Methods: Since 2000 34 cases of unilateral breast reconstruction with a four-zone unipedicle DIEAP flap (two cases) or a double-pedicle DIEAP flap (32 cases) have been performed. Preoperative examination of the superficial and deep epigastric vascular system with color doppler sonography (CDS) and/or multidetector-row CT (MDCT) were performed to assess the dominant abdominal perforator/s. If one or two large size, medially located perforators were identified and the superficial venous system showed vascular connections between right and left hemiabdomen, it was possible to use an unipedicle four-zone DIEAP flap with an additional anastomosis of the superficial vein. If this specific vascular situation did not exist, a double-pedicle DIEAP flap was raised.

Results: There were no major complications, and very satisfactory results have been obtained.

Conclusions: This retrospective study showed that both options of raising a large DIEAP flap for unilateral breast reconstruction, namely unipedicled flap based on large medial perforator/s plus additional venous discharge or double-pedicle flap, are safe. Preoperative examination of the dominant perforator/s with CDS and/or MDCT is mandatory in both cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/micr.20715DOI Listing
July 2010

The value of multidetector-row CT angiography for pre-operative planning of breast reconstruction with deep inferior epigastric arterial perforator flaps.

Br J Radiol 2010 Jan 6;83(985):40-3. Epub 2009 Jul 6.

Breast Plastic and Reconstructive surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Collage, Beijing, China.

The deep inferior epigastric artery perforator (DIEP) flap has recently become the first option for breast reconstruction. However, the anatomy of the deep inferior epigastric artery varies greatly from one individual to another and even from one hemiabdomen to the other. An optimal pre-operative evaluation method that adequately maps the underlying vasculature has been lacking. The advent of multidetector-row CT (MDCT) angiography has proven highly accurate at detailing the vasculature, but no reports have documented its value during pre-operative planning. From December 2006 to May 2008, 22 consecutive patients who underwent MDCT angiography before breast reconstruction using DIEP flaps were selected as the test group, and 22 former patients who did not undergo MDCT before the same procedure were selected as the control group. The two groups were evaluated for the ratio of pre-operative redesign, intra-operative method changes, time spent on flap harvest and the ratio of flap-associated complications. The pre-operative redesign ratio was 22.7% in the test group and 0% in the control group. The intra-operative method change ratio was 0% in the test group and 13.6% in the control group. The mean time spent on flap harvest was 2.8 +/- 0.2 h in the test group and 4.4 +/- 0.2 h in the control group (p<0.05). The flap complication rate was 1/22 in the test group and 3/22 in the control group (p _ 0.04). In conclusion, use of MDCT angiography during pre-operative planning promotes a significant reduction in operating time and complication rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1259/bjr/29140440DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487255PMC
January 2010

Breast augmentation by autologous fat injection grafting: management and clinical analysis of complications.

Ann Plast Surg 2009 Aug;63(2):124-7

Center for Mammoplasty and Breast Reconstruction, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.

Autologous fat is an excellent soft-tissue filler, given its abundance and ease of harvest. Nevertheless, the technique is accompanied by postoperative complications such as fat necrosis, calcification, and sclerotic nodules. These problems directly influence surgical efficacy. Computed tomography or magnetic resonance imaging was used to confirm the location of abnormal adipose tissue preoperatively. Depending on the characteristics of the lesion, the liquefied fat was aspirated or the sclerotic lesion excised. Pressurized dressings were used postoperatively for both techniques. Seventeen patients who experienced complications after autologous fat injection were treated. Pathologic examination of excised samples demonstrated changes including fat necrosis, calcification, hyalinization, and fibroplasia. Intramammary autologous fat injection should only be used with caution. Selecting suitable indications and correct surgical techniques make autologous fat grafting an ideal method for breast augmentation. Strictly controlling the injection volume and injecting diffusely in multiple layers to allow fat granules to distribute evenly within the breast, are effective methods to reduce postoperative complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SAP.0b013e318189a98aDOI Listing
August 2009

Transaxillary dual-plane augmentation mammaplasty: experience with 98 breasts.

J Plast Reconstr Aesthet Surg 2009 Nov 5;62(11):1459-63. Epub 2008 Oct 5.

Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijng, PR China.

The dual plane technique is a popular procedure for breast augmentation. However, traditional dual-plane augmentation mammaplasty usually requires incisions through the areola or inframammary crease, which produces a scar on the breast. Therefore, women may not favour this technique, especially Chinese women who are genetically susceptible to hyperplastic scars. In our institution, endoscopic transaxillary dual-plane augmentation mammaplasty was performed in patients under general anaesthesia. Incisions (4 cm long) were designed to overlap the natural creases of the skin bilaterally behind the mid-transaxillary frontline. The space behind the pectoralis major muscle was separated conventionally. Assisted by a 10mm/30 degrees endoscope, part of the ectopectoralis was excised. Through the transaxillary incision, the rough-surfaced silicone gel breast prosthesis was implanted. The volume varied from 185 to 315 g, and a routine indwelling drainage tube was inserted. From March 2006 to May 2007, we performed 49 cases of augmentation mammaplasty applying endoscopic-assisted dual-plane technique. At 6- to 12-month follow up, the surgical outcomes were satisfactory. There were no complications, such as capsular contracture, bleeding, scar hyperplasia, or infection. We believe that the dual-plane augmentation mammaplasty can be performed via transaxillary incision using an endoscope. Since the surgical incision is far from the front of the breast with this method, no scarring of the breast develops. Furthermore, the adoption of the dual-plane technique provides superior form to the anatomical prosthesis in the breast, alleviates postoperative pain, and improves suppleness of the postoperative breast.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjps.2008.05.044DOI Listing
November 2009

[Overlapping tissue expansion techniques and its clinical applications].

Zhonghua Zheng Xing Wai Ke Za Zhi 2002 Nov;18(6):369-70

Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing 100041, China.

Objective: To improve the results of the soft tissue expansion technique.

Methods: Two expanders were buried in the same soft tissue pocket in an overlapping pattern. The inflation process was carried out routinely.

Results: 19 cases of various tissue defects were treated with the overlapping tissue expansion technique since March 1999. Good results have been achieved.

Conclusion: The overlapping tissue expansion technique can provide much more expanded tissue and reduce complications compared with the traditional expansion technique. It is especially suitable for repair of the defects at the facial and cervical region.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2002

[Clinical study of the hemodynamics of both ends (proximal and distal) of internal mammary artery and its following-up].

Zhonghua Zheng Xing Wai Ke Za Zhi 2002 May;18(3):140-2

Plastic Surgery Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100041, China.

Objective: To verify the value of retrograde flow of Internal Mammary Artery (IMA) used as one of the supplying arteries and to develop a new method of applying IMA in breast reconstruction.

Methods: During breast reconstruction with free bilateral transverse rectus abdominis myocutaneous (TRAM) flap, the pressures and velocities of the two ends (proximal and distal) of internal mammary artery as well as the according perfusion unit (PU) of TRAM were measured in two patients who suffered from mammectomy because of carcinoma.

Results: The pressure at distal end was 66 or/and 58 mmHg, the pressure at proximal end was 88 or/and 75 mmHg, the former is 75%-77% of the later. The immediate rate of blood flow of distal anastomotic stoma was 74 or/and 52 ml/min, that of proximal was 94 or/and 70 ml/min, the former is 74%-78% of the later after anastomosed to the two sides of deep inferior epigastric arteries (DIEA) separately. Under condition that both ends (proximal and distal) of IMA contributing as the supplying blood vessels simultaneously, the PU of TRAM was the best. The rates of blood flow at the two anastomotic stomas are similar to each other in late stage (evaluated at the fifth year follow-up).

Conclusion: The distal end of internal mammary artery can supply blood flow in a considerable level, similar with the proximal end.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2002

Breast reconstruction with the free bipedicled inferior TRAM flap by anastomosis to the proximal and distal ends of the internal mammary vessels.

J Reconstr Microsurg 2002 Apr;18(3):161-8

Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. China.

Breast reconstruction after traditional radical mastectomy is particularly challenging for the plastic surgeon. Not only the breast, but subclavian and anterior axillary-fold deformities need to be corrected. An entire TRAM flap (including zone IV) is required, and bipedicled deep inferior epigastric vessels are needed to insure that the entire flap will survive completely. However, on the chest, it is difficult to locate the two suitable sets of recipient vessels for the two pedicles. The thoracodorsal vessels have usually been damaged during axillary dissection or radiation therapy. In the past, the proximal ends of the internal mammary artery and vein (IMA, IMV) have been used as recipient vessels with free flaps, with ligation of the distal ends. These authors have used both the proximal and distal ends of the IMA and IMV as recipient vessels for end-to-end anastomoses to the bipedicled deep inferior epigastric vessels (DIEA, DIEV) in seven clinical cases, with very satisfactory results obtained. Anatomic studies of the IMA and IMV were done in 10 dogs and two active patients, including studying hemodynamic changes at the proximal and distal ends of the IMA, and evaluation of perfusion units in the free bilateral TRAM flap. In the animal experiments, the mean pressure at the distal ends was 86/77 mmHg (left sides) and 87/78 mmHg (right sides); pressure was 63 to 71 percent of the proximal ends (p<0.05). There was no statistically significant difference between the pressures on the left and right sides. In the two patients, and in 5 others, the pressure at the distal ends was 66 and 58 mmHg, which was 75 to 77% of the pressure at the proximal ends. The blood flow at the two anastomotic stomas was similar in a 5-year follow-up. The clinical and experimental studies showed that the distal IMA has reduced perfusion pressure, but that it provides excellent flow and flap perfusion, allowing reliable use of two pedicles for survival of the entire flap.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-2002-28498DOI Listing
April 2002
-->