Direct delayed breast reconstruction with TAP flap, implant and acellular dermal matrix (TAPIA)

Børsen-Koch, Mikkel; Gunnarsson, Gudjon Leifur; Udesen, Ann; Arffmann, Susanne; Jacobs, Joseph B.; Salzberg, Andrew; Thomsen, Jørn Bo

doi:10.1016/j.bjps.2015.02.004

Cited by 22 publications

(41 citation statements)

References 29 publications

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“…Since 2011 the propeller TAP flap has increasingly been replacing the classic LD flap in our practice for delayed breast reconstruction where muscle is not required [4][5][6][7][8] . This is largely due to the surgical modifications described in this article.…”

Section: Discussionmentioning

confidence: 99%

“…branching pattern of the feeding vessels through the muscle to the subcutaneous tissue 4,6,9 . This enables a more comfortable flap design and speeds up the surgical procedure as the dissection is relatively easy to perform once the perforators have been identified and marked out.…”

Section: Discussionmentioning

confidence: 99%

“…In a few cases a small back-cut into the anterior edge of the LD muscle is necessary to enable In the course of time our flap insertion has changed as well. Initially, we inserted the flap where the mastectomy scar was located to replace the missing breast mound 4,5 . However, we have noticed that the best recipient site for the flap is the lateral and inferior part of the intended breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…We introduced the TAPIA (Thoracodorsal artery perforator flap, implant and acellular dermal matrix) concept, shortly after the introduction of acellular dermal matrix (ADM) in Europe in 2011; a combined use of a propeller TAP flap, an ADM and an implant for delayed breast reconstruction 4,5 . The use of preoperative color Doppler ultrasound (CDU) for perforator localization has enabled us to modify the design of our flap over time 6 .…”

mentioning

confidence: 99%

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Propeller TAP flap breast reconstruction: A simplified surgical technique

Gunnarsson

Holm

Duus

et al. 2018

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Propeller TAP flap breast reconstruction: A simplified surgical technique

Gunnarsson

Holm

Duus

et al. 2018

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…A recently published paper describes the TAPIA method for delayed breast reconstruction (1). When this technique is used the patients mobilize quickly following the reconstruction and postoperative complications seem scarce.…”

Section: Introductionmentioning

confidence: 99%

Thermal injury in TAPIA breast reconstruction—thermal injury to thoracodorsal artery perforator flap

Børsen-Koch¹,

Gunnarsson²,

Sørensen³

et al. 2017

Gland Surg.

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This paper presents two case reports on thermal injury to a breast reconstructed by the TAPIA method. In both cases the injuries were caused by excessive sun exposure. Thermal injury to flaps used in breast reconstruction has previously been described but most commonly in abdominal flaps, which may be due to the relative high frequency of this type of reconstructions. Reports of thermal injury to reconstructions using the Latissimus Dorsi flap are rare. The injuries previously described are most often caused by severe heat exposure. The thoracodorsal artery perforator (TAP)-flap can be used as an alternative to the Latissimus Dorsi flap but it may be more susceptible to thermal insult due to the total denervation, the restricted blood supply and the limited thickness of the flap. Precautions are recommended to avoid this type of injury. Gland Surg 2017;6(1):110-113 gs.amegroups.com Case 2A 48-year-old woman diagnosed with invasive ductal carcinoma in 2001 was treated by a right-sided mastectomy without adjuvant therapy. The patient was a non-smoker and apart from well-treated hypertension she had no comorbidity. She was reconstructed by the TAPIA method in April 2013 using a 365 cc Becker implant. She was discharged day 11 after an uneventful postoperative course.The patient presented with a satisfying result at the first postoperative control in the outpatient clinic three weeks after surgery. However, one week later she presented with a full-thickness skin burn, measuring 8 cm × 6 cm ( Figure 2A). She too had been exposed to the sun in hot weather wearing a dark shirt not exposing the flap to direct sunlight. The defect was debrided, revealing a viable flap underneath ( Figure 2B). We applied negative pressure wound therapy for 14 days and then covered the defect with a full-thickness skin graft ( Figure 2C). The nipple areola complex have since been reconstructed using a skate-flap and a tattoo ( Figure 2D). DiscussionThermal injury following breast reconstructions is a rare incident. The first case was reported more than two decades ago and since only few cases have been reported and compiled in two literary reviews (9,11). Most of the published material covers complete autologous reconstructions using either DIEP or TRAM flaps.The most frequent cause of thermal injury to the flaps seems to be heat exposure due to sunlight most often when the patient has been wearing dark clothes or bathing suits (3,9). The extent of the injury varies but most published cases have been treated conservatively. Approximately 16% required surgical revision and application of a skin graft (11).The etiology behind the increased risk of thermal injury is multi factorial. It is well documented that the sensibility of a reconstructed breast is scarce, especially in the initial period following reconstruction (9). The reconstruction seems to be most susceptible to thermal injury in the early postoperative period. However, the flaps tend to regain some autoregulation and sensitivity over time, however the duration may depend...

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