291 results match your criteria Breast Reconstruction Other Free Flaps


The Profunda Artery Perforator Flap: A Versatile Option for Head and Neck Reconstruction.

Plast Reconstr Surg 2021 May 10. Epub 2021 May 10.

From the Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center.

Background: Although the profunda artery perforator flap has gained popularity in breast reconstruction, it has not been well described for reconstruction of head and neck defects. The authors report their experience with free profunda artery perforator flaps in postoncologic head and neck reconstruction.

Methods: A retrospective review of all free profunda artery perforator flaps used for head and neck reconstruction from 2016 to 2019 was performed. Read More

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Breast Reconstruction with Non-Abdominal Autologous Tissue.

Chirurgia (Bucur) 2021 Mar-Apr;116(2 Suppl):136-142

The progresses in surgical field are amazing regarding the possibilities of soft tissue reconstruction. Techniques of breast reconstruction have been evolved since the last 40 years. There was a trend from pedicled flaps toward microsurgical free flaps. Read More

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Septocutaneous gluteal artery perforator flap in breast reconstruction: An insight into the related anatomy and preoperative imaging.

J Plast Reconstr Aesthet Surg 2021 Mar 30. Epub 2021 Mar 30.

Chief of Service, Plastic and Reconstructive Surgery Service, Hospital Universitario Ramon y Cajal, Madrid, Spain.

Background: Although without a widespread popularity, the septocutaneous gluteal artery perforator flap (sc-GAP) can be an excellent choice in breast reconstruction. The purpose of the article is to further study the preoperative imaging anatomy and surgical technique for a safe operation.

Patients And Methods: A clinical experience in four unilateral breast reconstructions is reported, and an analysis is made of the computed tomography angiography (CTA) variables (36 studies/72 sides) that might define the microsurgical consistency and reliability of the technique. Read More

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Preoperative Long-term Therapeutic Subcutaneous Heparin Administration into Abdomen: Possible Cause for Nonobstructive Microvascular Flap Failure.

Plast Reconstr Surg Glob Open 2021 Feb 17;9(2):e3400. Epub 2021 Feb 17.

Department of Plastic and Reconstructive Surgery, University Hospitals Birmingham Foundation Trust, Birmingham, United Kingdom.

The anterioabdominal wall is the most common site for low molecular weight heparin administration for anticoagulation, either for prophylactic or for therapeutic indications. Occasionally, this could be associated with damage of the abdominal pannus microvasculature, which could possibly jeopardize the reliability of free abdominal flaps as deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle, especially with therapeutic anticoagulation therapy. These flaps are reliant on a highly intricate complex vascular anatomy and perforasomes for their adequate perfusion and survival. Read More

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February 2021

The Impact of Prior Abdominal Surgery on Complications of Abdominally Based Autologous Breast Reconstruction: A Systematic Review and Meta-Analysis.

J Reconstr Microsurg 2021 Mar 1. Epub 2021 Mar 1.

Department of Surgery, Division of Plastic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Background:  Approximately half of all patients presenting for autologous breast reconstruction have abdominal scars from prior surgery, the presence of which is considered by some a relative contraindication for abdominally based reconstruction. This meta-analysis examines the impact of prior abdominal surgery on the complication profile of breast reconstruction with abdominally based free tissue transfer.

Methods:  Literature search was conducted using PubMed, Scopus, and Web of Science. Read More

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Alternative flaps in autologous breast reconstruction.

Gland Surg 2021 Jan;10(1):444-459

Memorial Sloan Kettering Cancer Center, New York, NY, USA.

The gold standard for autologous reconstruction in the post-mastectomy patient remains the deep inferior epigastric artery perforator flap, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap) and trunk (lumbar artery perforator flap, superior and inferior gluteal artery perforator flaps). This study will review the history, relevant anatomy, surgical technique and outcomes for alternative flaps in autologous reconstruction. Read More

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January 2021

Free tissue transfer after unsatisfactorily implant-based breast reconstruction, a cohort study.

J Plast Reconstr Aesthet Surg 2021 Jan 30. Epub 2021 Jan 30.

Department of Plastic Surgery, Norfolk and Norwich University Hospital, Norwich, UK.

Breast reconstruction can be performed using implants or autologous tissue, either alone or in combination. Implants typically require re-operation during the patient's lifetime, often for adverse capsular contracture. Conversion from implants to autologous tissue may improve symptoms and deliver a definitive reconstruction. Read More

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January 2021

Variation in Payment per Work Relative Value Unit for Breast Reconstruction and Nonbreast Microsurgical Reconstruction: An All-Payer Claims Database Analysis.

Plast Reconstr Surg 2021 03;147(3):505-513

From the Plastic and Reconstructive Surgery Service, Department of Surgery, and the Department of Finance, Memorial Sloan Kettering Cancer Center; the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center; and the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.

Background: Commercial payments for implant-based breast reconstruction have increased within the past decade, whereas reimbursements have stagnated for microsurgical techniques. The physician payment-to-work relative value unit ratio allows for standardization when comparing procedures of differing complexity. This study aimed to characterize payment per work relative value unit for common breast and nonbreast microsurgical procedures. Read More

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Enhanced recovery after breast reconstruction with a pedicled Latissimus Dorsi flap-A prospective clinical study.

J Plast Reconstr Aesthet Surg 2020 Dec 9. Epub 2020 Dec 9.

Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.

Introduction: We have previously implemented and published an enhanced recovery after surgery (ERAS) program for autologous breast reconstruction using DIEP flaps. The latissimus dorsi (LD) flap is another commonly used flap for autologous breast reconstruction (ABR). The aim of the present study was to use our experience from the ERAS program in DIEP flap reconstruction to optimize our LD breast reconstruction program. Read More

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December 2020

Effect of intravenous lidocaine on ischemia-reperfusion injury in DIEP microsurgical breast reconstruction. A prospective double-blind randomized controlled clinical trial.

J Plast Reconstr Aesthet Surg 2021 Apr 24;74(4):809-818. Epub 2020 Oct 24.

Department of Oncology, Autonomous University of Madrid, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain.

Background: Ischemia-reperfusion injury in free flaps is associated with tissue damage and is one of the main factors causing flap failure in reconstructive microsurgery. The aim of this study is to assess whether any ischemia-reperfusion injury takes place during a microsurgical flap reconstruction as seen through the levels of malondialdehyde (MDA) and superoxide dismutase, biomarkers of oxidative stress, and to analyze the effect of lidocaine in this process.

Methods: Twenty-four patients operated for immediate breast reconstruction using the Deep Inferior Epigastric Perforator free flap technique were divided into two groups: one group was treated with a lidocaine intravenous perfusion and the other group with a saline perfusion. Read More

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Transversus Abdominis Plane Block With Liposomal Bupivacaine Versus Thoracic Epidural for Postoperative Analgesia After Deep Inferior Epigastric Artery Perforator Flap-Based Breast Reconstruction.

Ann Plast Surg 2020 12;85(6):e24-e26

Department of Plastic and Reconstructive Surgery, University of Kansas, Kansas City, KS.

Purpose: Autologous breast reconstruction with abdominally based free flaps has traditionally been associated with a longer hospital stay and higher initial cost relative to other reconstructive methods. One important component of this course is postoperative pain control. Thoracic epidural anesthesia is considered among the most effective methods for pain control in the immediate postoperative period following these procedures. Read More

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December 2020

Internal mammary artery perforators as recipient vessels for free tissue transfer in head and neck reconstruction: A case report and literature review.

Microsurgery 2021 May 7;41(4):355-360. Epub 2020 Nov 7.

Department of Otolaryngology, Head & Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.

Head and neck defect reconstruction is a common challenge for plastic surgeons. Microsurgical free tissue transfer is a frequently used solution but its success strictly depends on the quality of recipient vessels. A particularly demanding situation occurs when there are no nearby available vessels because of previous extensive neck dissection and radiotherapy. Read More

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Prevalence and Utilization of Obturator Artery Anatomic Variant in Autologous Breast Reconstruction.

J Reconstr Microsurg 2021 Mar 8;37(3):256-262. Epub 2020 Oct 8.

Midwest Breast & Aesthetic Surgery, Columbus, Ohio.

Background:  The objective of this study is to quantify the prevalence and describe the utilization of an anatomic vascular variant in which the obturator artery (OA) arises from the trunk of the deep inferior epigastric artery (DIEA) in stacked/dual-pedicled autologous breast reconstruction. When this variant is identified preoperatively on computed tomography angiography (CTA), it may be utilized in a "flow-through" fashion to direct antegrade internal mammary artery (IMA) flow into a second free flap to facilitate anastomotic arrangement and optimize perfusion.

Methods:  Preoperatively obtained abdomen/pelvis CTA imaging of 121 autologous breast reconstruction patients were retrospectively reviewed for the unilateral or bilateral presence of the OA branch arising from the DIEA (OA variant). Read More

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The Hybrid Latissimus Dorsi Flap in Immediate Breast Reconstruction: A Comparative Study With the Abdominal-Based Flap.

Ann Plast Surg 2021 04;86(4):394-399

From the Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Korea.

Purpose: The implant-enhanced latissimus dorsi (LD) flap, or a hybrid LD flap, is widely used in certain indications, even though abdominal-based flaps are now considered the gold standard of autologous breast reconstruction. However, few articles distinguish the hybrid LD flap from traditional LD flaps, and not many articles have compared the surgical outcomes, with the abdominal-based flap procedure, especially in the area of immediate breast reconstruction. In addition, it is often overlooked that the reported esthetic comparisons are based on different populations and contralateral balancing procedures (CBPs). Read More

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A Critical Examination of Length of Stay in Autologous Breast Reconstruction: A National Surgical Quality Improvement Program Analysis.

Plast Reconstr Surg 2021 01;147(1):24-33

From George Washington University School of Medicine and Health Sciences; and the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; and the Department of Surgery, George Washington University Hospital.

Background: This study aims to use the National Surgical Quality Improvement Program database to identify factors associated with extended postoperative length of stay after breast reconstruction with free tissue transfer.

Methods: Consecutive cases of breast reconstruction with free tissue transfer were retrieved from the National Surgical Quality Improvement Program (2005 to 2017) database using CPT code 19364. Extended length of stay (dependent variable) was defined as greater than 5 days. Read More

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January 2021

"Does ERAS benefit higher BMI patients? A single institutional review".

J Plast Reconstr Aesthet Surg 2021 03 10;74(3):475-479. Epub 2020 Sep 10.

Division of Plastic Surgery, Department of Surgery, Baylor Scott & White Medical Center-Temple, 2401 S. 31st Street MS-01-E443, Temple, TX 76508, United States. Electronic address:

Background: Enhanced recovery after surgery (ERAS) is increasingly used in plastic surgery to optimize patient care. Mitigating the risk of postoperative complications is particularly important in patients with risk factors, such as obesity. The objective of this study is to evaluate the impact of the ERAS pathway in patients, stratified by BMI, undergoing free flap breast reconstruction on length of stay and complications. Read More

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Superiomedial Pedicle Breast Reduction for Gigantic Breast Hypertrophy: Experience in 341 Breasts and Suggested Safety Modifications.

Aesthetic Plast Surg 2021 04 22;45(2):375-385. Epub 2020 Sep 22.

Department of Plastic and Reconstructive Surgery, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel.

Background: Reduction mammoplasty in patients with gigantic breast hypertrophy runs a high risk of complication. Traditionally, inferior pedicle reductions or free nipple grafting techniques have been recommended for gigantic breasts on the basis of measurements and expected resection weights. The superiomedial pedicle (SMP) technique has been less commonly used, due to concerns of vascular inadequacy. Read More

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Unique Techniques or Approaches in Microvascular and Microlymphatic Surgery.

Clin Plast Surg 2020 Oct;47(4):649-661

Department of Plastic Surgery, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí 89, Barcelona 08026, Spain.

Several methods can be used for identifying tissues for transfer in donor-site-depleted patients. A fillet flap can be temporarily stored in other parts of the body and transferred back to the site of tissue defect, including covering the amputated stump of the lower extremity. Human arm transplant is rare and has some unique concerns for the surgery and postsurgical treatment. Read More

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October 2020

Autologous tissue reconstruction after mastectomy-A cross-sectional survey of 110 hospitals in China.

Eur J Surg Oncol 2020 12 29;46(12):2202-2207. Epub 2020 Jul 29.

Department of Breast Surgery, Fudan University Shanghai Cancer Center and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. Electronic address:

Background: Autologous reconstruction after mastectomy became more and more popular, so this study aimed to obtain up-to-date and comprehensive data on autologous reconstruction in China.

Methods: An electronic questionnaire was sent to 110 hospitals, which were chosen depending on geographical distribution and hospital types. The questionnaire investigated the demographics, characteristics, breast cancer treatment and reconstruction situation of these hospitals through different modules. Read More

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December 2020

Clinical Impact of DIEP Flap Perforator Characteristics - A Prospective Indocyanine Green Fluorescence Imaging Study.

J Plast Reconstr Aesthet Surg 2020 Aug 23;73(8):1526-1533. Epub 2020 Jan 23.

Centre for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.

Background: The question to what extent perfusion in deep inferior epigastric perforator (DIEP) flaps depends on specific perforator characteristics has been raised. Anatomical studies and previous clinical trials focussing on DIEP flap perfusion resulted in discrepancies. This prospective study investigates how perforator row, number and diameter affect DIEP flap microperfusion via Indocyanine Green (ICG) fluorescence angiography. Read More

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An Individualized Patient-centric Approach and Evolution towards Total Autologous Free Flap Breast Reconstruction in an Academic Setting.

Plast Reconstr Surg Glob Open 2020 Apr 7;8(4):e2681. Epub 2020 Apr 7.

Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.

Advances with newer perforator flaps and complex microsurgical techniques have enabled creative solutions in autologous breast reconstruction. For patients seeking total autologous breast reconstruction without the use of implants, body regions other than the abdomen have emerged to provide a substitute or additional donor tissue. In cases where abdominal perforator flaps are not possible (as with prior abdominoplasty), flaps taken from the lower back or thigh can be used. Read More

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Secondary "Hybrid Reconstruction" Concept with Silicone Implants After Autologous Breast Reconstruction - Is It Safe and Reasonable?

Med Sci Monit 2020 May 10;26:e921329. Epub 2020 May 10.

Department of Plastic and Hand Surgery, University of Erlangen, Erlangen, Germany.

BACKGROUND The use of autologous tissue for breast reconstructive surgery following mastectomy has become routine and allows for excellent symmetry and aesthetic results. However, in some cases, the amount of tissue available from the utilized flaps is not enough to achieve the desired outcome. The use of autologous fat grafting, as well as other techniques, has been described to deal with such problems. Read More

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[Effects of pedicled rectus abdominis myocutaneous flap combined with free deep inferior epigastric artery perforator flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy].

Zhonghua Shao Shang Za Zhi 2020 Apr;36(4):297-303

Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha 410008, China.

To explore the effects of pedicled rectus abdominis myocutaneous (PRAM)flap combined with free deep inferior epigastric artery perforator (DIEAP) flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy. From October 2014 to September 2016, 9 patients with upper limb lymphedema after mastectomy were treated with PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap for breast reconstruction and upper limb lymphedema treatment in Hunan Province Cancer Hospital. The patients were all females, aged 34-66 (44±7) years. Read More

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Direct-to-Implant, Prepectoral Breast Reconstruction: A Single-Surgeon Experience with 201 Consecutive Patients.

Plast Reconstr Surg 2020 04;145(4):686e-696e

From the Division of Plastic and Reconstructive Surgery, McGill University; and the Divisions of Surgical Oncology and Plastic and Reconstructive Surgery, Jewish General Hospital.

Background: The resurgence of prepectoral breast reconstruction has brought strict patient inclusion and exclusion criteria by numerous authors. This article provides an overview of a single surgeon's experience with 201 patients, 313 breasts using immediate, direct-to-implant prepectoral breast reconstruction. The article compares surgical outcomes of different patient cohorts to elucidate risk factors that may predispose patients toward developing complications. Read More

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The use of venous anastomotic flow couplers to monitor buried free DIEP flap reconstructions following nipple-sparing mastectomy.

JPRAS Open 2020 Mar 4;23:50-54. Epub 2019 Nov 4.

Department of Plastic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom.

Nipple sparing mastectomy with free tissue transfer for breast reconstruction offers excellent aesthetic outcomes but poses a challenge in monitoring the buried flap. Venous anastomotic flow couplers directly monitor buried flaps without the need for monitoring skin paddles. In a two year period we used the Synovis GEM™ flow coupler on 24 DIEP flaps. Read More

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Intraoperative Laser-Assisted Indocyanine Green Imaging Can Reduce the Rate of Fat Necrosis in Microsurgical Breast Reconstruction.

Plast Reconstr Surg 2020 03;145(3):507e-513e

From the Division of Plastic and Reconstructive Surgery, Stanford University Medical Center.

Background: Fat necrosis following microsurgical breast reconstruction is common and problematic for patients and surgeons alike. Indocyanine green angiography provides a means of evaluating flap perfusion at the time of surgery to inform judicious excision of hypoperfused tissue. The authors hypothesized that incorporation of protocolized indocyanine green-informed flap débridement at the time of surgery would decrease the incidence of fat necrosis. Read More

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The perforator flap from the contralateral large healthy breast as an alternative for breast reconstruction or combined breast and thoracic reconstruction.

Microsurgery 2020 Jul 18;40(5):568-575. Epub 2020 Feb 18.

Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, PR China.

Background: It has been demonstrated that contralateral breast tissue can be used for delayed breast reconstruction. The current report presented the clinical outcomes of the perforator flap from the contralateral lower breast as a pedicled flap for immediate or delayed breast reconstruction and as a free flap for delayed breast reconstruction or simultaneous breast and thoracic reconstruction in patients with macromastia.

Methods: From June 2014 to August 2018, a total of 15 female patients with a mastectomy defect on one side and a large healthy breast on the other side were collected in our department. Read More

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The Effects of Adjunctive Pain Medications on Postoperative Inpatient Opioid Use in Abdominally Based Microsurgical Breast Reconstruction.

Ann Plast Surg 2020 11;85(5):e3-e6

From the Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA.

Background: The purposes of this study were to quantify the amount of opioid medication used postoperatively in the hospital setting after abdominally based microsurgical breast reconstruction, to determine factors that are associated with increased opioid use, and to identify other adjunctive medications that may contribute to decreased opioid use.

Methods: An electronic medical record data pull was performed at the University of Pennsylvania from November 2016 to October 2018. Cases were identified using Current Procedural Terminology code 19364. Read More

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November 2020

Oncologic outcomes after immediate breast reconstruction following mastectomy: comparison of implant and flap using propensity score matching.

BMC Cancer 2020 Jan 30;20(1):78. Epub 2020 Jan 30.

Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, South Korea.

Background: Although immediate breast reconstruction has been reported to be oncologically safe, no affirmative study comparing the two reconstruction methods exists. We investigated breast cancer recurrence rates in two breast reconstruction types; implant reconstruction and autologous flap reconstruction.

Methods: A retrospective cohort study was performed on propensity score-matched (for age, stage, estrogen receptor status) patients who underwent IBR after mastectomy at Seoul National University Hospital between 2010 and 2014. Read More

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January 2020

Immediate breast reconstruction with latissimus dorsi flap for patients with local recurrence of breast cancer.

Eur J Surg Oncol 2020 06 11;46(6):1013-1020. Epub 2020 Jan 11.

Multimedica, Milan, Italy.

Background: Ipsilateral breast cancer recurrence (IBTR) occurs in about 7% of patients with primary invasive breast tumor. Salvage mastectomy and breast reconstruction are often discussed and latissimus dorsi (LD) flap is frequently proposed.

Methods: We retrospectively investigated 111 consecutive locally relapsing patients who underwent salvage mastectomy and immediate LD reconstruction. Read More

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