A safe approach to sparing the rectus muscle in abdominal-based microvascular breast reconstruction—TRAM, MS-TRAM, DIEP or SIEA?

A safe approach to sparing the rectus muscle in abdominal-based microvascular breast... There has been an international drive towards the use of abdominal-based perforator (deep inferior epigastric perforator (DIEP) or superficial inferior epigastric artery (SIEA)) flaps for breast reconstruction as they provide the ideal tissue whilst minimizing donor site morbidity, post-operative pain and recovery times. Ultimately, what is desired is a safe and reliable reconstruction. We retrospectively reviewed 245 consecutive abdominal-based free flaps performed by three surgeons at a single institution between January 2002 and March 2008. Primary breast reconstructions were planned as DIEPs, but a safe, flexible approach to flap selection was adopted with the most appropriate flap performed depending on the perforator anatomy at the time of surgery. Chest wall resurfacing procedures for extensive recurrent disease, inflammatory breast carcinoma or following radionecrosis were planned as transverse rectus abdominis myocutaneous (TRAM) flaps. The incidence of flap complications was compared including total and partial flap loss, returns to operating room, seroma, abdominal hernia/bulge, fat necrosis and delayed wound healing. Patient age, body mass index (BMI), smoking status, co-morbidity and pre- and post-operative radiotherapy were recorded. Two hundred patients, mean age 48 years (range, 26–74 years), underwent a total of 245 abdominal-based microvascular breast reconstructions. Twelve salvage TRAM flaps were performed for chest wall resurfacing. Of the remaining 233 flaps, 151 (65%) were immediate and 82 (35%) were delayed reconstructions. Flaps included 171 DIEPs, 38 muscle-sparing (MS)-TRAMs, 2 TRAMs and 22 SIEA flaps. Of the 233 reconstructions, 39 flaps (16.7%) in 31 patients received radiotherapy. Mean follow-up was 2.6 years. There were three (1.3%) complete flap losses and three (1.3%) partial flap losses. Rates of fat necrosis were 3.0% and abdominal hernia/bulge 1.7%. We present an algorithm to aid decision-making in autologous breast reconstruction that reflects our safe flexible approach. We have achieved excellent success rates in autologous breast reconstruction and conclude that in order to minimize complications, a safe flexible approach towards muscle harvest must be maintained in our drive to use perforator flaps. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Plastic Surgery Springer Journals

A safe approach to sparing the rectus muscle in abdominal-based microvascular breast reconstruction—TRAM, MS-TRAM, DIEP or SIEA?

Loading next page...
 
/lp/springer_journal/a-safe-approach-to-sparing-the-rectus-muscle-in-abdominal-based-JDvRVAvtfd
Publisher
Springer Journals
Copyright
Copyright © 2012 by Springer-Verlag
Subject
Medicine & Public Health; Plastic Surgery
ISSN
0930-343X
eISSN
1435-0130
D.O.I.
10.1007/s00238-011-0667-x
Publisher site
See Article on Publisher Site

Abstract

There has been an international drive towards the use of abdominal-based perforator (deep inferior epigastric perforator (DIEP) or superficial inferior epigastric artery (SIEA)) flaps for breast reconstruction as they provide the ideal tissue whilst minimizing donor site morbidity, post-operative pain and recovery times. Ultimately, what is desired is a safe and reliable reconstruction. We retrospectively reviewed 245 consecutive abdominal-based free flaps performed by three surgeons at a single institution between January 2002 and March 2008. Primary breast reconstructions were planned as DIEPs, but a safe, flexible approach to flap selection was adopted with the most appropriate flap performed depending on the perforator anatomy at the time of surgery. Chest wall resurfacing procedures for extensive recurrent disease, inflammatory breast carcinoma or following radionecrosis were planned as transverse rectus abdominis myocutaneous (TRAM) flaps. The incidence of flap complications was compared including total and partial flap loss, returns to operating room, seroma, abdominal hernia/bulge, fat necrosis and delayed wound healing. Patient age, body mass index (BMI), smoking status, co-morbidity and pre- and post-operative radiotherapy were recorded. Two hundred patients, mean age 48 years (range, 26–74 years), underwent a total of 245 abdominal-based microvascular breast reconstructions. Twelve salvage TRAM flaps were performed for chest wall resurfacing. Of the remaining 233 flaps, 151 (65%) were immediate and 82 (35%) were delayed reconstructions. Flaps included 171 DIEPs, 38 muscle-sparing (MS)-TRAMs, 2 TRAMs and 22 SIEA flaps. Of the 233 reconstructions, 39 flaps (16.7%) in 31 patients received radiotherapy. Mean follow-up was 2.6 years. There were three (1.3%) complete flap losses and three (1.3%) partial flap losses. Rates of fat necrosis were 3.0% and abdominal hernia/bulge 1.7%. We present an algorithm to aid decision-making in autologous breast reconstruction that reflects our safe flexible approach. We have achieved excellent success rates in autologous breast reconstruction and conclude that in order to minimize complications, a safe flexible approach towards muscle harvest must be maintained in our drive to use perforator flaps.

Journal

European Journal of Plastic SurgerySpringer Journals

Published: Sep 1, 2012

References

  • Deep inferior epigastric perforator flap for breast reconstruction
    Allen, RJ; Treece, P
  • Establishing the case for CT angiography in the preoperative imaging of abdominal wall perforators
    Rozen, WM; Ashton, MW; Grinsell, D
  • Does the preoperative imaging of perforators with CT angiography improve operative outcomes in breast reconstruction?
    Rozen, WM; Anavekar, NS; Ashton, MW

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off