Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap

Heitmann, Christoph; Felmerer, Gunther; Durmus, C.; Matejic, Branislav; Ingianni, G.

doi:10.1054/bjps.1999.3257

Cited by 88 publications

(45 citation statements)

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“…However, because it does not include the deep inferior epigastric artery, which covers the main blood flow of the lower abdomen, there is a great risk for partial flap necrosis. 9,10 Also, because the transverse rectus abdominis muscle is included in the flap of the pedicled TRAM flap, there is a higher possibility of donor complications, such as abdominal wall weakness, than for the free TRAM flap, which uses the deep inferior epigastric vessel perforator. 11,12 The "supercharge" concept was introduced to augment the blood flow of the pedicled TRAM flap.…”

Section: Discussionmentioning

confidence: 99%

Use of Internal Mammary Vessel Perforator as a Recipient Vessel for Free TRAM Breast Reconstruction

Park

Lee

Chung

et al. 2003

Annals of Plastic Surgery

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Breast reconstruction is a cosmetically critical procedure for women and it must be undertaken to balance the shape, size, and position of the breast with the other breast. Since the first introduction of the free abdominoplasty flap in 1979, the transverse rectus abdominis musculocutaneous (TRAM) flap technique has been a widely accepted method of breast reconstruction after mastectomy. In breast reconstruction with a free flap, the selection of suitable recipient vessels is the critical decision to be made by the surgeon. The most common recipient vessel for free flap breast reconstruction is the axillary system. However, when used as a recipient, the axillary system may limit flap movement and flexibility in breast shaping. The use of the internal mammary vessels as a recipient site attains ideal breast symmetry. However, the technique requires partial rib resection and eliminates the opportunity for a potential coronary artery bypass graft, which requires the internal mammary artery. Based on these considerations, the selection of suitable recipient vessels constitutes an important requirement for successful free tissue transfer. The authors have performed breast reconstruction with the TRAM flap anastomosed to the internal mammary perforator vessel and conclude that these perforators could be useful as recipient vessels, especially in the case of immediate breast reconstruction with the free TRAM flap.

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Section: Discussionmentioning

confidence: 99%

Use of Internal Mammary Vessel Perforator as a Recipient Vessel for Free TRAM Breast Reconstruction

Park

Lee

Chung

et al. 2003

Annals of Plastic Surgery

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“…Nesta etapa é necessário, (KOSHIMA et al, 1992;TREECE, 1994;BLONDEEL et al, 1998;HAMDI et al, 1999;HEITMANN et al, 2000;MUNHOZ et al, 2001;MRAKBY;MILNER, 2002;VANDEVOORT et al, 2002;CRAIGIE et al, 2003;MUNHOZ et al, 2004a;GILL et al, 2004). O estudo anatômico pelos métodos radiológicos (HADDAD, 1968;BOYD et al, 1984;TAYLOR et al, 1984;MOON;TAYLOR, 1988) é válido e permite a visualização das artérias epigástricas inferiores e dos principais ramos perfurantes musculares.…”

Section: Discussão ___________________________________unclassified

“…O ponto de referência anatômico representado pelo umbigo é citado por diversos autores como a localização preferencial das artérias perfurantes (HADDAD, 1968;BROWN et al, 1975;BOYD et al, 1984;TAYLOR et al, 1984;MILLER et al, 1988;MOON;TAYLOR, 1988;SOEDA, 1989;NAHAI, 1997;HEITMANN et al, 2000;CRAIGIE et al, 2003).…”

Section: Discussão ___________________________________unclassified

“…Alguns autores citaram o ponto de referência representado pelo umbigo como a localização preferencial para as artérias perfurantes de maior calibre (HADDAD, 1968;BROWN et al, 1975;TAYLOR et al, 1984;MILLER et al, 1988;MOON;TAYLOR, 1988;SOEDA, 1989;NAHAI, 1997;HEITMANN et al, 2000;CRAIGIE et al, 2003). Outros autores como PENNINGTON et al (1980) Na presente análise observou-se a relação entre as artérias perfurantes de maior calibre e as regiões específicas do músculo reto do abdome.…”

Section: Discussão ___________________________________unclassified

“…Associado a estas descrições anatômicas, diversos autores informaram sobre suas experiências clínicas o que permitiu a obtenção de dados mais detalhados sobre a vascularização dos músculos reto do abdome, as artérias perfurantes e a sua distribuição no tecido subcutâneo e na pele (MILLOY et al, 1960;HADDAD, 1968;BROWN et al, 1975;NAHAI et al, 1976;HOLMSTRÖM, 1979;BOYD et al, 1984;HESTER et al, 1984;TAYLOR et al, 1984;MILLER et al, 1988;MOON;TAYLOR, 1988;KOSHIMA et al, 1992;ITOH;ARAI, 1993;TREECE 1994;BLONDEEL et al, 1998;BLONDEEL et al, 1999;HAMDI et al, 1999;HEITMANN et al, 2000;MUNHOZ et al, 2001;MRAKBY;MILNER, 2002;VANDEVOORT et al, 2002;CRAIGIE et al, 2003;GRAF et al, 2004;MUNHOZ et al, 2004a;MUNHOZ et al, 2004b).…”

Section: Introdução ___________________________________unclassified

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Estudo crítico da anatomia arterial do retalho vascularizado pela artéria perfurante muscular da artéria epigástrica inferior

Munhoz¹

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Breast reconstruction

Blondeel

and

Tromaropoulos

2015

Plastic and Reconstructive Surgery

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The presence of breasts is a defining feature of adult mammalian gender. It must therefore be considered an essential element of human femininity, and the role it plays in female psychology cannot be understated. 1,2 The requirement for reconstruction of the female breast is almost exclusively consequent on breast surgery for breast cancer.Providers are becoming legally bound to educate and prepare patients who require mastectomy for reconstruction, such that informed choices can be made. They are obliged to offer a mul tidisciplinary setting as part of a care pathway, in particular allowing for cross-specialty engagement to allow for immediate reconstruction. The surgery of reconstruction has become a recognized specialist area, which by virtue of its appreciation of three-dimensional form, and its possible call on microsurgical skills, naturally falls within the domain and skill set of the plastic surgeon.In this chapter the techniques of breast reconstruction and the principles behind them are reviewed, and it is hoped this will offer the practitioner a ready reference for what we trust will be a meticulously if not passionately executed endeavour. reconstructive aimsAny attempt at reconstruction should appreciate the nuances of breast form, volume and its complex three dimensionality. Its position on the chest wall is determined by its footprint, 3-5 a fixed entity that does not change with age, and that is set by the inframammary fold (IMF) at the 6-7th rib inferiorly, the 2nd rib superiorly, 1-2 cm behind the anterior axillary line laterally, and the lateral border of the sternum medially. The footprint sets the basic breast position on the chest, and by complementing the opposite side creates the necessary foundation for symmetry.The breast conus represents the tissue that projects from the chest wall, a complex of skin envelope with its glandular and fatty content that falls inferiorly to a variable extent over the IMF in a manner termed ptosis. Unlike the footprint, the conus is variable with age. Creating, therefore, a symmetrical ptotic conus precisely positioned on the breast footprint embodies the art of breast reconstructive sculpture. The skin envelope aids in determining shape and any damage or removal of skin will influence its final shape. The ultimate goal of breast reconstruc tion is to create symmetrical, natural-looking breasts and not necessarily a specific shape or volume. aesthetic and functional considerationsBreast ideals have changed over time, as depicted in art and reflecting past and existing cultural differences. There is also a potential variation between what the surgeon and the patient perceives as aesthetic. For this reason it is critical to be attentive to the patient's wishes, appreciating that simple breast symmetry rather than an idealized form may well be their preference.However, insofar as it is possible to specify what an ideal breast should be, the following can be stated: 6 • Breast size relates to the size and shape of the torso.• Nipple placement is critical -ideall...

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Anatomical features of perforator blood vessels in the deep inferior epigastric perforator flap

Cited by 88 publications

References 14 publications

Use of Internal Mammary Vessel Perforator as a Recipient Vessel for Free TRAM Breast Reconstruction

Use of Internal Mammary Vessel Perforator as a Recipient Vessel for Free TRAM Breast Reconstruction

Estudo crítico da anatomia arterial do retalho vascularizado pela artéria perfurante muscular da artéria epigástrica inferior

Breast reconstruction

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