1,608 results match your criteria Breast Reconstruction Perforator Flap


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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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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Transverse upper abdominal scars in DIEP flaps: pushing the limit of donor site abdominal skin perfusion.

Ann R Coll Surg Engl 2021 May;103(5):e169-e172

The Royal Marsden, London, UK.

We present two immediate breast reconstruction cases utilising deep inferior epigastric perforator (DIEP) flaps in the presence of upper transverse abdominal scars and their outcomes. The available evidence in relation to its impact on abdominal skin perfusion and published clinical experience is reviewed. Read More

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Conventional CT versus Dedicated CT Angiography in DIEP Flap Planning: A Feasibility Study.

J Pers Med 2021 Apr 7;11(4). Epub 2021 Apr 7.

Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.

The deep inferior epigastric perforator (DIEP) flap is used with increasing frequency in post-mastectomy breast reconstruction. Preoperative mapping with CT angiography (CTa) is crucial in reducing surgical complications and optimizing surgical techniques. Our study's goal was to investigate the accuracy of conventional CT (cCT), performed during disease staging, compared to CTa in preoperative DIEP flap planning. Read More

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Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series.

J Plast Reconstr Aesthet Surg 2021 Mar 29. Epub 2021 Mar 29.

Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226 USA. Electronic address:

Background: Venous thromboembolism (VTE) is a potentially devastating complication following abdominally based microsurgical breast reconstruction, with a reported incidence of 0.08-4%. The authors aim to describe disease presentation and clinical course following VTE diagnosis in patients within their practice. Read More

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Systematic review of partial breast reconstruction with pedicled perforator artery flaps: Clinical, oncological and cosmetic outcomes.

Eur J Surg Oncol 2021 Apr 13. Epub 2021 Apr 13.

Honorary Senior Lecturer, Birmingham University, Consultant Oncoplastic Surgeon, The Royal Wolverhampton NHS Trust, England, UK.

The use of chest wall perforator flaps (CWPFs) following breast conservation surgery for breast cancer has become a useful tool in the armamentarium of the oncoplastic breast surgeon, however robust evidence for the technique is lacking. The aim of this study was to conduct a systematic review appraising the current evidence for the use of CWPFs, evaluating clinical, oncological and cosmetic outcomes. A PRISMA-compliant systematic review, with PROSPERO published protocol a priori and search of all relevant database and trial registries between 1990 to July 2020. Read More

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Preshaping DIEP Flaps: Simplifying and Optimizing Breast Reconstruction Aesthetics.

Plast Reconstr Surg 2021 May;147(5):1059-1061

From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center; and the Division of Plastic and Reconstructive Surgery, University of Iowa Hospitals and Clinics.

Summary: One key component of a successful autologous breast reconstruction is insetting the flap to accurately resemble an aesthetic breast. The authors describe a novel technique used to shape a deep inferior epigastric artery perforator flap into a coned breast mound before introducing it into the breast pocket. With the flap perfusing on the chest wall, an area of skin estimating the size and location of the skin paddle is marked. Read More

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The Conjoined TUGPAP Flap for Breast Reconstruction: Systematic Review and Illustrative Anatomy.

Plast Reconstr Surg Glob Open 2021 Apr 20;9(4):e3512. Epub 2021 Apr 20.

The Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.

Background: Although abdominally based flaps continue to be the gold standard for autologous breast reconstruction, alternative donor sites are necessary when the abdominal region is unavailable or inadequate for flap harvest. In this case, thigh-based flaps, such as the profunda artery perforator (PAP), transverse upper gracilis (TUG), or newly described TUGPAP, are thought to be reliable with low morbidity and satisfactory cosmesis. The objective of this study was to perform a systematic review of breast reconstruction with PAP, TUG, or TUGPAP, and present anatomy and surgical techniques through illustrative examples. Read More

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Radiotherapy-associated angiosarcoma in the breast reconstructed by autologous free-flap and treated with electrochemotherapy.

Radiol Oncol 2020 Dec 29;55(1):77-81. Epub 2020 Dec 29.

Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.

Background: Radiotherapy-associated angiosarcoma (RAA) of the breast is a rare complication of radiotherapy, which is often difficult to identify and has poor prognosis. It usually presents as violaceous skin, erythema or rapidly growing palpable firm mass that can be confused with other benign skin lesions.

Patients And Methods: After reviewing the literature, we found only four cases with RAA after mastectomy and autologous breast reconstruction. Read More

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December 2020

Efficacy of Closed Incision Negative Pressure Wound Therapy on Abdominal Donor Site After Free Flap Breast Reconstruction.

Wounds 2021 Apr;33(4):81-85

Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas.

Introduction: Negative pressure wound therapy (NPWT) has been used to treat acute and chronic wounds in a variety of scenarios. Specifically, in autologous breast reconstruction, studies investigating the use of closed incision NPWT (ciNPWT) in breast surgery are lacking.

Objective: The aim of this study was to analyze the use of ciNPWT at the abdominal donor site following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Read More

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Stratification of Surgical Risk in DIEP Breast Reconstruction Based on Classification of Obesity.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana.

Background:  From both a medical and surgical perspective, obese breast cancer patients are considered to possess higher risk when undergoing autologous breast reconstruction relative to nonobese patients. However, few studies have evaluated the continuum of risk across the full range of obesity. This study sought to compare surgical risk between the three World Health Organization (WHO) classes of obesity in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. Read More

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The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients.

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Seoul, Korea.

Background:  The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated.

Methods:  Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. Read More

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Do Patient Expectations of Discharge Affect Length of Stay after Deep Inferior Epigastric Perforator Flap for Breast Reconstruction?

J Reconstr Microsurg 2021 Apr 14. Epub 2021 Apr 14.

Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.

Introduction:  Deep inferior epigastric artery perforator (DIEP) flap is a common method of breast reconstruction. Enhanced recovery after surgery (ERAS) postoperative protocols have been used to optimize patient outcomes and facilitate shorter hospital stays. The effect of patient expectations on length of stay (LOS) after DIEP has not been evaluated. Read More

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Overall Complication Rates of DIEP Flap Breast Reconstructions in Germany-A Multi-Center Analysis Based on the DGPRÄC Prospective National Online Registry for Microsurgical Breast Reconstructions.

J Clin Med 2021 Mar 2;10(5). Epub 2021 Mar 2.

Department of Plastic and Aesthetic Surgery, Hand Surgery, Helios Hospital Emil von Behring, 14165 Berlin, Germany.

While autologous breast reconstruction has gained momentum over recent years, there is limited data on the structure and quality of care of microsurgical breast reconstruction in Germany. Using the breast reconstruction database established by the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC), the presented study investigated the overall outcomes of deep inferior epigastric perforator (DIEP) flap reconstructions in Germany. Data of 3926 patients and 4577 DIEP flaps performed by 22 centers were included in this study. Read More

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The influence of venous system patterns on DIEP flap viability for breast reconstruction.

J Plast Surg Hand Surg 2021 Mar 26:1-7. Epub 2021 Mar 26.

Department of Endocrine and Breast Surgery, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan.

A deep inferior epigastric artery perforator (DIEP) flap has unique variations in the anatomy of the vascular supply, and this idea has been adapted to the venous system. Venous system patterns, including connections between the superficial and deep inferior epigastric vein (SDC) or connections of the superficial inferior epigastric vein across the midline-crossing linking veins (MCLV), have gradually become recognized as a cause of fat necrosis and induration due to venous congestion. Therefore, it is important to select patients who are appropriate for transplantation by evaluating blood flow in the flap based on these patterns. Read More

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Application of intraoperative indocyanine green angiography for detecting flap congestion in the use of free deep inferior epigastric perforator flaps for breast reconstruction.

Microsurgery 2021 Mar 25. Epub 2021 Mar 25.

Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.

Background: The use of intraoperative indocyanine green (ICG) angiography has been well documented for confirmation of arterial perfusion in transferred free flaps. However, no previous report has yet focused on whether ICG angiography can be used to detect congestion in free flaps. The present report investigates the feasibility of ICG angiography for detecting flap congestion intraoperatively through illustrative cases. Read More

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Use of a combined SIEA and SCIP based double pedicled abdominal flap for breast reconstruction.

Microsurgery 2021 Mar 7. Epub 2021 Mar 7.

Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Tokyo, Japan.

Background: Recently, the deep inferior epigastric perforator (DIEP) flap has become the gold standard for breast reconstruction, but it has some drawbacks such as abdominal bulging and hernia. To overcome these disadvantages, the superficial inferior epigastric artery perforator (SIEA) flap is used as an alternative option, but it has another problem, namely limited vascular territory and risk of vascular thrombosis. To solve these problems, we introduced our new technique, a combined SIEA and superficial circumflex iliac artery perforator (SCIP) based double pedicled abdominal flap. 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

Good health-related quality-of-life and high patient-reported satisfaction after delayed breast reconstruction with pedicled flaps from the back.

J Plast Reconstr Aesthet Surg 2020 Dec 13. Epub 2020 Dec 13.

Department of Plastic Surgery, Lillebaelt Hospital, Vejle, Denmark; Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.

Background: This paper presents the results of a randomized controlled trial (RCT) that focus on health-related quality-of-life (QoL) and patient-reported satisfaction following breast reconstruction with pedicled flaps from the back.

Materials & Methods: We included women for unilateral delayed breast reconstruction. Patients were randomized to reconstruction by either a latissimus dorsi (LD) flap or a thoracodorsal artery perforator (TAP) flap. Read More

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December 2020

Post-mastectomy sensory recovery and restoration.

Gland Surg 2021 Jan;10(1):494-497

Weill Cornell Medical College, Houston Methodist Institute for Reconstructive Surgery, Houston, TX, USA.

Breast sensation has recently become an integral aspect of the reconstructive goal after mastectomy and is an important consideration for many patients. Neurotization techniques using primary coaptation, autograft, allograft, or nerve conduit have been used for autologous flaps, such as the deep inferior epigastric perforator (DIEP) flap. Outcomes have shown improved sensation and faster sensory recovery in the flap skin in immediate neurotized DIEP flap breast reconstructions compared to delayed reconstruction. Read More

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January 2021

Minimally invasive robotic breast reconstruction surgery.

Gland Surg 2021 Jan;10(1):469-478

Department of Plastic Surgery, MD Anderson Cancer Center, Houston, TX, USA.

The rising popularity of robotic surgery has enabled surgeons to continue to expand the uses of robotic surgery. Robotic surgery offers minimally invasive approaches coupled with tremor elimination, up to seven degrees of freedom, ergonomic positioning, 3D magnified vision and improved resolution. We describe robotic surgery techniques for nipple-sparing mastectomies, latissimus dorsi muscle flap harvest, deep inferior epigastric perforator (DIEP) flap pedicle harvest, and robotic microsurgical anastomoses. Read More

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January 2021

Combined deep inferior epigastric artery perforator flap with vascularized groin lymph node transplant for treatment of breast cancer-related lymphedema.

Gland Surg 2021 Jan;10(1):460-468

Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

For survivors of breast cancer lymphedema is their greatest survivorship burden. Modern surgical techniques to treat lymphedema are effective at reducing limb volume, symptoms of lymphedema, episodes of cellulitis, and improving patient quality of life. Physiologic procedures, including lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT), restore physiological lymphatic function within the affected extremity. Read More

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January 2021

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

The impact of age on patient-reported outcomes after oncoplastic versus conventional breast cancer surgery.

Breast Cancer Res Treat 2021 Feb 19. Epub 2021 Feb 19.

Breast Center, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.

Purpose: Some studies have indicated age-specific differences in quality of life (QoL) among breast cancer (BC) patients. The aim of this study was to compare patient-reported outcomes after conventional and oncoplastic breast surgery in two distinct age groups.

Methods: Patients who underwent oncoplastic and conventional breast surgery for stage I-III BC, between 6/2011-3/2019, were identified from a prospectively maintained database. Read More

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February 2021

Thoracoacromial artery and vein as main recipient vessels in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction.

J Surg Oncol 2021 Apr 10;123(5):1232-1237. Epub 2021 Feb 10.

Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine (NCGM), Tokyo, Japan.

Background: The internal mammary artery/vein (IMA/V) are commonly used recipients for free flap breast reconstruction, but requires costal cartilage resection and limits future use of the IMA. This study aimed to evaluate the feasibility of the thoracoacromial artery/vein (TAA/V) as recipients for deep inferior epigastric artery perforator (DIEP) flap breast reconstruction compared with using the IMA/V.

Methods: Medical charts of patients who underwent free DIEP flap breast reconstruction using the TAA/V or the IMA/V as recipient vessels were reviewed. Read More

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Reverse Lymph Node Mapping Using Indocyanine Green Lymphography: A Step Forward in Minimizing Donor-Site Morbidity in Vascularized Lymph Node Transfer.

Plast Reconstr Surg 2021 Feb;147(2):207e-212e

From the Departments of Plastic and Reconstructive Surgery and Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autonòma de Barcelona; and the Department of Plastic and Reconstructive Surgery, Al-Azhar University Hospitals.

Background: Reverse lymphatic mapping before harvesting a lymph node flap is crucial to avoid donor-site lymphedema; however, the technique is complex and unavailable in many centers. The authors introduce radioisotope-free reverse lymphatic mapping using indocyanine green and Patent Blue dye.

Methods: The authors conducted a prospective study in patients undergoing free vascularized groin lymph node transfer for postmastectomy upper extremity lymphedema. Read More

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February 2021

Breast Reconstruction Using the Lateral Thoracic, Thoracodorsal, and Intercostal Arteries Perforator Flaps.

Plast Reconstr Surg Glob Open 2021 Jan 14;9(1):e3334. Epub 2021 Jan 14.

Clinica di Chirurgia Plastica e Ricostruttiva, Ospedale Policlinico San Martino e Sezione di Chirurgia Plastica, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate - DISC, Università degli Studi di Genova, Genova, Italy.

Breast-conserving surgery followed by radiotherapy represents the standard of care for early-stage breast cancer. The aim of this article was to provide a review of the literature about the use of the lateral thoracic artery perforator (LTAP) flap, the lateral thoracodorsal (LTD) flap, and the lateral intercostal artery perforator (LICAP) flap in lateral partial breast defect.

Methods: A literature search was performed via PubMed, Medline, and Cochrane. Read More

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January 2021

infection following mastectomy and breast reconstruction requiring triple antibiotic therapy and surgical debridement.

BMJ Case Rep 2021 Feb 4;14(2). Epub 2021 Feb 4.

Infectious Disease, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

A 40-year-old woman was referred to infectious disease specialists for a skin infection following mastectomy and bilateral reconstruction with deep inferior epigastric perforator flap. Her case demonstrates the difficulty in treating non-tuberculosis mycobacterial infections, especially the rarely seen species. She failed to respond to dual antibiotic therapy containing imipenem-cilastin despite reported sensitivity. Read More

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February 2021

Six-year experience of oncoplastic volume replacement using local perforator flaps.

J Plast Reconstr Aesthet Surg 2021 Jan 9. Epub 2021 Jan 9.

Nightingale Breast Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.

Local perforator flaps may be utilised to correct volume defects after breast-conserving surgery (BCS), improving the cosmetic outcome and avoiding the need for contralateral symmetrising surgery. The aims of this study were to assess longer term oncological outcomes following local perforator flap reconstruction, and to demonstrate the learning curve associated with incorporating such techniques within routine clinical practice. We report a consecutive case series of 116 local perforator flaps performed between January 2014 and May 2020. Read More

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January 2021