Background Donor site seroma formation and prolonged drainage duration are commonly seen after harvest of perforator‐based abdominal flaps. The lymphatic network including the lymphatic vessels and the lymph nodes can be traumatized during harvest of a perforator‐based abdominal flap, eventually causing seroma formation. The aim of this study was to compare postoperative seroma occurrence rates between the deep system group including the deep inferior epigastric artery perforator (DIEP) flap and the superficial system group comprised of the superficial inferior epigastric artery (SIEA) flap, the superficial circumflex iliac artery perforator (SCIP) flap, and the SIEA‐SCIP combined flap. Patients and methods A retrospective analysis of all patients who underwent unilateral breast reconstruction using perforator‐based abdominal flaps from June 2020 to May 2021 was performed. The patients were divided into the deep system group and the superficial system group. Propensity score matching was used to compare in the two groups the mean duration of drainage in the donor site and the occurrence of postoperative aspiration. Covariates included sex, age, body mass index, history of smoking, past history of diabetes mellitus. One hundred and fifteen patients (the deep system group, n = 100 and the superficial system group, n = 15) met inclusion criteria for a 1:1 match performed on 14 deep system group patients using propensity scores, with 14 superficial system group patients having similar characteristics. Results The mean duration of drainage in the donor site was shorter in the deep system group (6.6 ± 1.9 days) than in the superficial system group (9.3 ± 2.3 days, p < .01). The occurrence rate of postoperative aspiration was lower in the deep system group (0%) than in the superficial system group (50%, p < .01). Conclusions Although superficial abdominal perforator flaps are considered to be less invasive than the DIEP flap, they are associated with prolonged donor site drainage and more frequent occurrence rate of postoperative aspiration.
upermicrosurgery techniques are essential skills for lymphatic surgery or perforator-flap surgery. Living animal models, such as rodents, are considered to be ideal microsurgical training models. However, the use of living animal models is costly and involves bioethical considerations.The egg-in-cube, developed by Huang et al., 1 is a novel artificial eggshell with a functionalized surface, which allows high observability and accessibility for embryo manipulation to overcome the drawbacks of the chick chorioallantoic membrane models. We aimed to develop a novel, highly reproducible, and easy-to-handle supermicrosurgical anastomosis training system using the chicken embryo within the egg-in-cube. To our knowledge, this is the first report to show a supermicrosurgical anastomosis training system using a chicken embryo within an artificial eggshell. METHODSThe chicken embryo model within the egg-incube was created in accordance with previous articles. 1,2 The artificial cubic eggshell was fabricated by integrating a polycarbonate frame structure and five polydimethylsiloxane (PDMS) membranes, which have oxygen permeability. 1 In this study, fertilized chick eggs (Sakura; Gotofuranjyo Inc.) were Summary: Although supermicrosurgery techniques are essential skills for lymphatic surgery or perforator-flap surgery, an ideal training model is yet to be introduced. Living animal models, such as rodents, are considered to be ideal microsurgical training models. However, the use of living animal models is costly and involves bioethical considerations. Hence, the authors developed a novel, cost-effective, highly reproducible, and easy-to-handle supermicrosurgical anastomosis training system using the chicken embryo within the egg-in-cube system. Chick embryos were fertilized in the artificial cubic eggshell, which was fabricated by integrating a polycarbonate frame structure and five polydimethylsiloxane membranes. Seven days later, the trainees underwent supermicrosurgical training using the vitelline artery of the chick embryo. The trainees were able to perform supermicrosurgical training using all 11 surviving chicken embryos. The average diameter of the vitelline artery was 0.43 mm. Patency and pulsation were observed after the anastomosis in four of the 11 cases. The supermicrosurgical training system using the chicken embryo within the egg-in-cube system has several advantages. This system is ethically acceptable, less costly and easier to manage than other animal models, and suitable as a supermicrosurgical training model, such as for lymphovenular anastomosis, because the diameter of the vitelline artery was similar to that of the lymphatic vessels in patients with lymphedema. Moreover, the trainee can confirm patency and leakage after the anastomosis because this model has a circulation system. The trainee can practice the supermicrosurgical technique efficiently with simultaneous feedback on anastomosis results.
Summary: Postoperative chyle leakage is an uncommon type of lymphorrhea characterized by a milky white lymphatic fluid. Here, we report a case of postoperative donor-site chyle leakage after breast reconstruction using a deep inferior epigastric artery perforator (DIEP) flap. A 50-year-old woman underwent unilateral secondary breast reconstruction using a DIEP flap. On postoperative day (POD) 3, 50 mL of clear white liquid was observed in the abdominal suction drain over 12 hours. On POD 6, the amount of white-colored fluid in the left side suction drain increased to 190 mL/d with high triglyceride 674 mg/dL. The computed tomography scan showed no fluid collections intraabdominally, within the rectus abdominis muscle, or in the subcutaneous area. Based on the diagnosis of donor-site subcutaneous chyle leakage, the patient was treated with a low-fat diet, a medium-chain triglyceride diet, and compression of the contralateral groin area. The fluid became clear and decreased in quantity, and we removed the drain on POD 9. No abdominal fluid was observed after the discharge. Combined treatment with a low-fat diet and compression of the groin area may be effective for donor-site chyle leakage after breast reconstruction using the DIEP flap.
Summary: One of the complications of anal surgery or disease is anal stenosis. To release the tension of the anus, a tension-releasing incision in the perianal skin and various anoplasty procedures are usually considered. The aim of this article is to describe a straightforward technique with local flaps for severe anal stenosis after anal reconstruction. A 57-year-old man presented to the clinic with diverticulitis secondary to severe anal stenosis, and reported difficulty with defecation after perianal skin resection around the anus and surgery to create a V-Y advancement flap for perianal primary Paget disease 9 months previously. After improvement of the diverticulitis using antibiotics, bilateral transposition flaps were transferred to release the anal stenosis. The surgical treatment for severe anal stenosis has been known to entail several complications, including infection, incontinence, anal mucosal ectropion, pruritus, wound dehiscence, and restenosis. In this severe case, because the scars were situated at the 6 o’clock and 12 o’clock positions on the anus due to the previous V-Y advancement flap, bilateral rotation flaps were transferred from the 3 o’clock and 9 o’clock positions of the anus to prevent wound dehiscence and partial flap necrosis. Three months later, the size of the anus was unchanged, but additional surgery was performed at the patient’s request. A bilateral transposition flap procedure was used, with flaps designed and elevated from the 6 o’clock and 12 o’clock positions. The postoperative course was uneventful, and the anal stenosis was improved.
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