Displaying inguinal lymph nodes before transplantation in a deep inferior epigastric perforator flap breast reconstruction using an innovative projection method

Hummelink, Stefan; Kool, Leo J. Schultze; Ulrich, Dietmar

doi:10.1016/j.bjps.2015.10.041

Cited by 21 publications

(14 citation statements)

References 8 publications

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“…The fact that these nodes are small in size, situated at the subcutaneous fat level, and not always visible or palpable, make the flap elevation a demanding process for lymphedema surgeons. Although a number of different techniques using various imaging modalities have been described to facilitate LN flap elevation and diminish the risk of donor‐site complications, the most recent ISL 2016 consensus still recommends that further research, in terms of long‐term efficacy and improvement of current techniques, are required to avoid donor‐site lymphedema …”

Section: Discussionmentioning

confidence: 99%

“…Hummelink et al presented their experience using the computed tomography angiographies for virtual planning of LN transplantation associated to deep inferior epigastric artery perforator flap breast reconstruction. In the majority of the combined abdominal and lymphatic flaps, they identified only one LN, while it is not mentioned whether they performed a second vascular anastomosis to nourish directly the LN flap; however, it is well‐accepted that separate vascular anastomoses, using dominant pedicles, are preferable to be implemented, in order for the LN flap to be fully revascularized and regain its functionality …”

Section: Discussionmentioning

confidence: 99%

“…2016 consensus still recommends that further research, in terms of long-term efficacy and improvement of current techniques, are required to avoid donor-site lymphedema. 7,[17][18][19]21,22 Anatomical landmarks have been proposed to outline the groin intraoperatively, including the inguinal ligament, the inguinal skin crease, the anterior superior iliac spine, and the pubic tubercle as reference points. 23,24 However, it has been reported that normal lymph drainage of healthy lower limbs deteriorates with advancing age and indices of quantitative lymphoscintigraphy may be similarly affected.…”

Section: Improvement Of Upper-limb Lymphedema Was Documented Inmentioning

confidence: 99%

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Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Dionyssiou

Demiri

Sarafis

et al. 2019

Journal of Surgical Oncology

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Background A new technique named “Selected Lymph Node” (“SeLyN”) was evaluated, aiming to identify the most functional groin lymph nodes (LNs) for an effective LN transplantation. Methods Bilateral lower‐limb SPECT‐CT was performed in the upper‐limb lymphedema patients, to select the most radioactive inguinal LN. Recorded data included demographics, stage, etiology of lymphedema, flap consistency in accordance to preoperative findings, flap size, number of LN, and harvesting time. Infection episodes per year and volume changes of the upper limbs were documented. Donor‐site complications were recorded and lower‐limb evaluation was performed through clinical examination, volume analysis, and lymphoscintigraphy. Results A total of 41 patients underwent a “SeLyN” transfer technique. The mean flap size was 28.34 cm2 containing a mean of 3.4 LNs. The mean time spent on flap harvest was 39 minutes. A mean 56.5% volume reduction (P < .001) and a mean 1.41 to 0.29 infection episodes per patient per year (P < .001) were recorded. Clinical evaluation and lymphography of the donor site advocated no major complications for a mean follow‐up period of 42.5 months. Conclusions “SeLyN” is a safe and effective technique in selecting the most suitable LNs, minimizing the donor‐site morbidity, and decreasing the overall operating time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Improvement Of Upper-limb Lymphedema Was Documented Inmentioning

confidence: 99%

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Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Dionyssiou

Demiri

Sarafis

et al. 2019

Journal of Surgical Oncology

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“…Three patients underwent a unilateral, delayed breast reconstruction and three patients received a bilateral reconstruction (one immediate, one delayed reconstruction, and one delayed with the use of tissue expanders). All patients followed a standard pre-operative imaging protocol which consisted of a computed tomography angiography (CTA) scan for evaluation and 3D planning of perforators, and 3D photography of the torso for clinical documentation [ 13 , 14 ]. 3D images of the torso were obtained using a commercially available multi-camera set-up, 3dMD Body (3dMD, Atlanta, USA).…”

Section: Methods and Patientsmentioning

confidence: 99%

Applications and limitations of using patient-specific 3D printed molds in autologous breast reconstruction

et al. 2018

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BackgroundOver the last years, several techniques have been proposed to improve the outcome of autologous breast reconstruction procedures. One of these innovations describes patient-specific, three-dimensional (3D) printed breast molds for intraoperative use based on 3D stereophotogrammetry. In this article, we want to share our preliminary experiences with producing such templates, its clinical possibilities and limitations in practice. MethodsPatient-specific templates were designed based on 3D stereophotogrammetry images. The 3D template was fabricated using a 3D printer. During breast reconstruction, the autologous flap was placed inside the printed template to aid the surgeon in determining the shape and volume of the autologous flap creating the desired breast dimensions. Patients were 3D-photographed 6 to 9 months post-operatively. ResultsThree patients with unilateral breast reconstructions showed a width difference of 0.5 cm and mean volume difference of 211 ml between the reconstructed and contralateral breasts. In the three bilateral reconstructed patients, a mean difference in breast width and volume of respectively 0.5 cm and 16 ml was found. ConclusionsPatient-specific breast templates are inexpensive and relatively easy to design, while being practical and convenient to obtain insight in the dimensions of the desired breast during reconstruction, according to the operating surgeons. Patient selection is however critical, as patients must have sufficient donor volume and/or satisfying breast shape to be able to use the template to its full potential.Level of evidence: Level IV, therapeutic study.

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“…Additionally, the inguinal lymph nodes can be harvested along with this flap to treat upper extremity lymphedema in select patients. 35 Reports on the use of DIEP flaps for upper extremity reconstruction are rare and limited to a few case reports. Tang et al reported a series of 22 pediatric cases of using free DIEP flap for reconstruction of complex soft tissue defects of upper and lower extremities with an overall flap survival rate of 95.5%.…”

Section: Deep Inferior Epigastric Artery Perforator Flapmentioning

confidence: 99%

Versatility of Free Cutaneous Flaps for Upper Extremity Soft Tissue Reconstruction

et al. 2017

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The goals of upper extremity soft tissue reconstruction should go well beyond providing coverage and restoring function. As the field of reconstructive microsurgery has evolved, free cutaneous flaps (FCFs) are gaining wider application. The advantages of FCF include minimizing donor-site morbidity by preserving the muscle and fascia, improving versatility of flap design, and superior aesthetic results. This review highlights the application of anterolateral thigh, superficial circumflex iliac artery, deep inferior epigastric perforator, superficial inferior epigastric artery, and flow-through flaps for reconstruction of upper extremity defects. These flaps share several qualities in common: well-concealed donor sites, preservation of major arteries responsible of providing inflow to distal extremity, and potential for a two-team approach (donor and recipient sites). While the choice of flaps should be decided based on individual patient and defect characteristics, FCF should be considered as excellent options to achieve the goals of upper extremity reconstruction.

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Displaying inguinal lymph nodes before transplantation in a deep inferior epigastric perforator flap breast reconstruction using an innovative projection method

Cited by 21 publications

References 8 publications

Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Functional lymphatic reconstruction with the “Selected Lymph Node” technique guided by a SPECT‐CT lymphoscintigraphy

Applications and limitations of using patient-specific 3D printed molds in autologous breast reconstruction

Versatility of Free Cutaneous Flaps for Upper Extremity Soft Tissue Reconstruction

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