Pedicled superior epigastric perforator flap for reconstruction of a soft tissue defect at the ventral thoracic wall

Pedicled superior epigastric perforator flap for reconstruction of a soft tissue defect at the... The purpose of this paper is to present a new method of ventral chest wall reconstruction utilizing skin and fat from the abdominal wall pedicled on the superior epigastric artery and its comitant veins without sacrificing the rectus abdominis muscle. In a patient with a 13 × 15 cm left parasternal soft tissue defect of the thoracic wall, a paraumbilical perforator flap of skin and subcutaneous tissue was elevated with meticulous preparation of the perforators to the right superior epigastric vessels without sacrificing any muscle. The skin and fat island with its vascular pedicle was drawn through an epigastric subcutaneous tunnel to the ventral thorax and placed into the defect. Postoperative flap perfusion measured by laser Doppler flowmetry was excellent, abdominal wall reconstruction was easy, and 3 months after operation, the ability to perform sit-ups was as good as before the operation. In two further patients, we found the vascular anatomy to be unsuitable for this flap. The pedicled superior epigastric perforator (SEP) flap is suitable in certain cases but unreliable for reconstruction of soft tissue defects at the chest wall. Further investigations and operating experience may provide additional knowledge to allow wider and more secure use of the SEP flap. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Plastic Surgery Springer Journals

Pedicled superior epigastric perforator flap for reconstruction of a soft tissue defect at the ventral thoracic wall

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Publisher
Springer-Verlag
Copyright
Copyright © 2007 by Springer-Verlag
Subject
Medicine & Public Health; Plastic Surgery
ISSN
0930-343X
eISSN
1435-0130
D.O.I.
10.1007/s00238-007-0155-5
Publisher site
See Article on Publisher Site

Abstract

The purpose of this paper is to present a new method of ventral chest wall reconstruction utilizing skin and fat from the abdominal wall pedicled on the superior epigastric artery and its comitant veins without sacrificing the rectus abdominis muscle. In a patient with a 13 × 15 cm left parasternal soft tissue defect of the thoracic wall, a paraumbilical perforator flap of skin and subcutaneous tissue was elevated with meticulous preparation of the perforators to the right superior epigastric vessels without sacrificing any muscle. The skin and fat island with its vascular pedicle was drawn through an epigastric subcutaneous tunnel to the ventral thorax and placed into the defect. Postoperative flap perfusion measured by laser Doppler flowmetry was excellent, abdominal wall reconstruction was easy, and 3 months after operation, the ability to perform sit-ups was as good as before the operation. In two further patients, we found the vascular anatomy to be unsuitable for this flap. The pedicled superior epigastric perforator (SEP) flap is suitable in certain cases but unreliable for reconstruction of soft tissue defects at the chest wall. Further investigations and operating experience may provide additional knowledge to allow wider and more secure use of the SEP flap.

Journal

European Journal of Plastic SurgerySpringer Journals

Published: Nov 1, 2007

References

  • Deep inferior epigastric perforator flap for breast reconstruction
    Allen, RJ; Treece, P

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