Correlating the deep inferior epigastric artery branching pattern with type of abdominal free flap performed in a series of 145 breast reconstruction patients

Molina, A. Reche; Jones, ME; Hazari, Anita; Francis, I R; Nduka, Charles

doi:10.1308/003588412x13171221592050

Cited by 18 publications

(11 citation statements)

References 13 publications

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“…16,17,[19][20][21][22] Three studies did not have a comparison group (n ¼ 3). [23][24][25] Two articles were excluded because they used the same data as another article (n ¼ 2). 26,27 One study did not evaluate the impact of CTA (n ¼ 1).…”

Section: Article Selectionmentioning

confidence: 99%

Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review

Mossa-Basha

Lee

2017

J reconstr Microsurg

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CT angiogram (CTA) is widely believed to improve operative time and flap outcomes for perforator flap breast reconstruction, but the quality of the evidence is not known. We conducted a systematic review of the efficacy of preoperative CTA for abdominal perforator flap breast reconstruction. Inclusion criteria included published articles in English, CTA group, and control group, between 2000 and March 2013. Medline and PubMed were queried. Study quality criteria were developed based on standards of internal and external validity. One reviewer screened titles and abstracts. Two authors independently reviewed the full-text articles. Outcomes of interest were operative time and flap outcomes. Ten publications met inclusion criteria. Study designs included retrospective or mixed prospective-retrospective cohorts. In every study, the control group time period preceded the CTA group time period and no studies adjusted for improved surgical skill (i.e., learning curve effect). Sample sizes ranged from 41 to 357. Five studies did not perform or provide statistical analysis for the results presented. The mean quality rating was 2.8 (out of a maximum of 7). Seven of 10 studies found a shorter operative time with CTA. Two of nine studies found fewer partial flap failures with CTA. CTA is associated with shorter operative time, but some of this may be due to a learning curve effect. The evidence does not show a difference in flap outcomes. The evidence in support of preoperative CTA is limited and subject to bias due to study design.

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Section: Article Selectionmentioning

confidence: 99%

Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review

Mossa-Basha

Lee

2017

J reconstr Microsurg

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“…Preoperative imaging with CTA demonstrates improved clinical outcomes including decreased length of surgery, decreased flap loss rate, decreased hernia rate, decreased intraoperative blood loss, shorter mean inpatient stay, reduced learning curve when compared with handheld Doppler, and increased surgeon confidence [5][6][7][8][9][10][11][12][13]. Additionally, meta-analyses of preoperative imaging in DIEP flaps demonstrate improved clinical outcomes with CTA over color Doppler US, including overall flap-related complications, donor-site morbidity, and decreased length of surgery [19,22].…”

Section: Preoperative Imagingmentioning

confidence: 97%

“…The goal of preoperative imaging is to aid the surgical team in preoperative planning given the variability of the DIEA perforator branches anatomy between patients and even between the left and right hemi-abdomen of the same patient. Improved clinical outcomes with preoperative imaging have been shown (predominantly with CTA) to include decreased length of surgery, decreased flap loss rate, decreased hernia rate, decreased intraoperative blood loss, shorter mean inpatient stay, reduced learning curve when compared with handheld Doppler, and increased surgeon confidence [5][6][7][8][9][10][11][12][13].…”

Section: Preoperative Imagingmentioning

confidence: 99%

“…This unpredictable anatomy may lead to lengthy perforator vessel selection and therefore longer operative times when imaging is not used as part of the preoperative planning. Additionally, preoperative imaging planning that accurately maps the perforators and its branches leads to reduced operative time, reduced abdominal morbidity, and increased flap reliability [5][6][7][8][9][10][11][12][13].…”

Section: Introduction/backgroundmentioning

confidence: 99%

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ACR Appropriateness Criteria® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

Imaging

Oliva

Day

et al. 2017

Journal of the American College of Radiology

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Breast cancer is the most common malignancy in women in the United States. Breast reconstruction surgery is a commonly used therapy for patients with breast cancer. The technique for the deep inferior epigastric perforator flap uses a preserved rectus muscle, which decreases donor site morbidity. Accurate identification and measurement of the perforator branches of the deep inferior epigastric artery is pivotal during pre-operative planning so that the surgeon can prioritize the best vessel to use and ultimately improve clinical outcome. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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confidence: 99%

Omni‐tract^® assisted deep inferior epigastric artery perforator flap harvesting

et al. 2014

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Deep inferior epigastric vessels perforator (DIEP) flap elevation can be challenging depending on the patients anatomical condition. [1][2][3][4] As any perforator flap, safe perforator dissection is a must. For the microsurgeon working in solo or with less trained surgeons, optimal tissue retraction during dissection is very helpful, enhancing the visualization of the vessels and therefore reducing the likelihood of perforator or motor nerve damage. Stay hooks and elastic bands help during intramuscular dissection, but do not do a great job during suprafascial dissection or during submuscular dissection of the pedicle. We report the use of Omni-tractV R 5 separator during DIEP flap elevation. So far we have used this separator in four consecutive cases. The first case was a double free DIEP flap for lower extremity reconstruction. A 3.0 silk suture was used to hang the lateral corner of each DIEP flap to the separator during suprafascial dissection. The tension of the suture was adjusted while the dissection progressed from lateral to medial. This allowed for comfortable simultaneous elevation of both flaps. Once the perforators were located, the flaps remained hung during intramuscular dissection. After intramuscular dissection was completed, a rubber band fixed to the separator elevated a bundle of rectus abdominis muscle to assist during submuscular dissection of the pedicle. In the following cases (one single free DIEP flap for breast reconstruction and two bilateral breast reconstruction cases), the separator was used in the same way as formerly described (Fig. 1). In future cases, we are considering incorporating the use of the malleable swivel blade to push down the fascia transversalis during the submuscular dissection of the pedicle, making flap elevation even easier and more autonomous. In these cases, all perforators were successfully dissected with the assistance of the separator and all flaps were transferred without problems. We think the use of the separator eliminates the risk of inappropriate pulling of the flap or the muscle by the assistant surgeon during flap elevation, decreasing the risk of perforator damage. Using the retractor, each flap is easily hung from a stable bar, allowing comfortable dissection. In case of unexpected movement of the patient (i.e., premature lightening of the anesthesia), the traction from the sutures can be quickly released just by cutting the suture. The inset of the separator in the surgical field takes less than 5 min and it can be readily removed for abdominal closure. In a double DIEP flap elevation as in some of these cases, it helps for a twoteam approach for simultaneous bilateral DIEP flap harvesting, diminishing surgical time. This approach is highly appealing, especially considering the recent safety questionings in bilateral DIEP flap breast reconstruction. 6 In summary, to our knowledge, this is the first report of the use of Omni-tractV R for DIEP flap elevation, its use seems to be safe and it is especially helpful for double DIEP flap elevation.

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Correlating the deep inferior epigastric artery branching pattern with type of abdominal free flap performed in a series of 145 breast reconstruction patients

Cited by 18 publications

References 13 publications

Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review

Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review

ACR Appropriateness Criteria® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

Omni‐tract^® assisted deep inferior epigastric artery perforator flap harvesting

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Correlating the deep inferior epigastric artery branching pattern with type of abdominal free flap performed in a series of 145 breast reconstruction patients

Cited by 18 publications

References 13 publications

Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review

Impact of Preoperative Computed Tomography Angiogram on Abdominal Flap Breast Reconstruction Outcomes: A Systematic Review

ACR Appropriateness Criteria® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

Omni‐tract® assisted deep inferior epigastric artery perforator flap harvesting

Contact Info

Product

Resources

About

Omni‐tract^® assisted deep inferior epigastric artery perforator flap harvesting