A Head-to-Head Comparison between the Muscle-Sparing Free TRAM and the SIEA Flaps: Is the Rate of Flap Loss Worth the Gain in Abdominal Wall Function?

Selber, Jesse C.; Samra, Fares; Bristol, Mirar; Sonnad, Seema S.; Vega, Stephen J.; Wu, Liza C.; Serletti, Joseph M.

doi:10.1097/prs.0b013e31817d60b0

Cited by 77 publications

(53 citation statements)

References 13 publications

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“…Minimally impact on abdominal wall function as fascia is no disrupted [130,131] Limited volume [130,131] Tenuous blood supply [130] Higher rates of flap loss (2.9%) and re-operation (17.4%) [136] Not suitable for women with inadequate abdominal adiposity [132] Two-stage reconstruction (expander plus implant) Requires less skin than single-stage reconstructions [129] Multiple consultations required over several months [129,130] Tissue expanders require muscle coverage to prevent extrusion and to achieve adequate bulk [129,130] Additional procedure required to replace expander with implant [130] Non-autologous (Implant-based)…”

Section: Superior Inferior Epigastric Artery (Siea) Flapmentioning

confidence: 99%

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Rozen

Guio-Aguilar

et al. 2012

Breast Cancer Res Treat

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We outline five methods of preserving the IMA for future CABG: (1) lowering the level of DIEP flaps to the fourth- and fifth-intercostals spaces, (2) using the DIEP pedicle as an intermediary for CABG, (3) using IMA perforators to spare the IMA proper, (4) using and end-to-side anastomosis between the DIEP pedicle and IMA and (5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG.

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Section: Superior Inferior Epigastric Artery (Siea) Flapmentioning

confidence: 99%

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Rozen

Guio-Aguilar

et al. 2012

Breast Cancer Res Treat

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“…This variability has led to low rates of uptake of the use of this flap compared to the DIEP flap, and has been postulated to result in an increase in operative complications with the use of this flap, particularly partial flap necrosis, fat necrosis, and flap loss. 9,20 These difficulties have led to various algorithms for its use as a means to ensuring greater likelihoods of operative success. 15,16 The variability in the anatomy of the SIEA was first described by Taylor and Daniel, who found an absent SIEA in 35% of cadaveric dissections, and significant variability in its origin and branching pattern.…”

mentioning

confidence: 99%

The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: A clinical anatomical study

et al. 2010

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“…The evidence for this is provided by recent papers by Serletti [27][28]. A high-volume experienced surgeon with an enviably low 0.29% rate of failure in performing DIEP or free TRAM flaps has a 10x fold increase in failure to 2.9% when doing SIEA flaps [29]. This illustrates that the inherent survivability of some flaps may be beyond simply the same technical anastomosis.…”

Section: Discussionmentioning

confidence: 92%

Anatomy of Free Flap Failures: Dissection of a Series

Davison¹,

Clemens²,

Kochuba³

2013

MPS

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Introduction: Free flap success rates have remained stable in recent years ranging 93% to 98%. Historically, the causes of free flap failures were attributed to the surgeon's inexperience and technique. However, there are factors beyond the surgical anastomosis that contribute to flap failure. The purpose of this study is to review each case of total flap loss in detail to develop a better understanding of complications. Methods: A retrospective study was performed over eleven years in a single surgeon's practice, a predominantly head and neck reconstructive practice. All charts were independently reviewed. In patients who sustained total flap loss, a review was conducted of patient comorbidites, anesthesia records, perioperative and follow-up notes. Results: A total of 514 free flaps were performed. 76% (392) of these flaps were for head and neck reconstruction. There were 22 total flap losses (4%) and 26 partial flap losses (5%). Of the 22 total flap losses, four flaps were avulsed, five flaps were in patients later found to have coagulation disorders (homozygous mutations of the MTHFR gene and factor V Leiden), four patients were exposed to neosynephrine, two patients remained hypotensive perioperatively, and four delayed flap losses were attributed to pseudomonal infection. Five losses were technical or related to flap inexperience. Several representative case scenarios are illustrated. Conclusion: Careful review of free flap failures indicates that a thorough workup (particularly coagulation disorders), flap selection, surgeon to anesthesia communication, proper securing of the flap, and postoperative patient blood pressure and infection control have a greater part to play in this new era of anastomotic success.

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A Head-to-Head Comparison between the Muscle-Sparing Free TRAM and the SIEA Flaps: Is the Rate of Flap Loss Worth the Gain in Abdominal Wall Function?

Abstract: The SIEA flap has a lower rate of hernia/bulge and a higher rate of thrombotic complications. Because of the emotional and financial cost of these complications, the SIEA flap should be undertaken only if strict criteria are met.

Cited by 77 publications

References 13 publications

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: A clinical anatomical study

Anatomy of Free Flap Failures: Dissection of a Series

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