Needing a large DIEAP flap for unilateral breast reconstruction: Double‐pedicle flap and unipedicle flap with additional venous discharge

Salgarello, Marzia; Barone-Adesi, Liliana; Sturla, Marcella; Masetti, Riccardo; Mu, Lanhua

doi:10.1002/micr.20715

Cited by 11 publications

(5 citation statements)

References 14 publications

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“…Rothenberger et al suggested that the supercharging of the contralateral SIEV leads to an improved venous outflow particularly in flaps containing larger proportions of the contralateral zones ( 58 ). Also in patients with the need of a large flap it was possible to use a unipedicle four-zone DIEP flap with an additional anastomosis of the SIEV, if the superficial venous system showed strong vascular connections between right and left hemiabdomen ( 59 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recipient vessel for the SIEV can be any vein with an adequate caliber and length. Described in the literature are, among others, the thoracoacromial vein ( 60 , 61 ), the lateral thoracic vein ( 12 , 62 , 63 ), the circumflex scapular vein ( 5 , 64 ), the thoracodorsal vein, the basilic ( 65 ) und cephalic vein ( 6 , 17 , 66 , 67 ), the external jugular vein ( 9 , 59 ), the internal mammary vein ( 7 , 11 , 68 – 70 ) and its perforators ( 71 ). Rohde et al and later Sbitany et al described a flap salvage technique by anastomosing the ipsilateral SIEV to a venae comitantes of the deep inferior epigastric pedicle ( 72 , 73 ).…”

Section: Discussionmentioning

confidence: 99%

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Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

et al. 2023

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BackgroundAutologous breast reconstruction is highly regarded in reconstructive surgery after mastectomy. DIEP flap reconstruction represents the gold standard for autologous breast reconstruction. The major advantages of DIEP flap reconstruction are its adequate volume, large vascular caliber and pedicle length. Despite reliable anatomy, there are procedures where the plastic surgeon's creativity is required, not only to shape the new breast, but also to overcome microsurgical challenges. An important tool in these cases is the superficial epigastric vein (SIEV).Methods150 DIEP flap procedures performed between 2018 and 2021 were retrospectively evaluated for SIEV use. Intraoperative and postoperative data were analyzed. Rate of anastomosis revision, total and partial flap loss, fat necrosis and donor site complications were evaluated.ResultsIn a total of 150 breast reconstructions with a DIEP flap performed in our clinic, the SIEV was used in 5 cases. The indication for using the SIEV was to improve the venous drainage of the flap or as a graft to reconstruct the main artery perforator. Among the 5 cases, no flap loss occurred.ConclusionsUse of the SIEV is an excellent method to expand the microsurgical options in breast reconstruction with DIEP flap surgery. It provides a safe and reliable procedure to improve venous outflow in cases of inadequate outflow from the deep venous system. The SIEV could also provide a very good option for fast and reliable application as an interposition device in case of arterial complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

et al. 2023

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“…There are various surgical techniques to recruit the whole flap, including double pedicle, stacked flaps, and other methods to increase flap projection. 15 – 18 All these will increase the complexity of the surgery and, thereby put the patient at greater risk for complications. The patients at our institution often prefer to keep their original breast size.…”

Section: Discussionmentioning

confidence: 99%

The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions

Sjöberg

Weerd

2018

Plastic and Reconstructive Surgery - Global Open

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Background:Previous surgery or slim body configuration can limit the size of the available abdominal flap in autologous breast reconstruction. However, redundant skin and subcutaneous tissue lateral to the mastectomy site can be utilized as the pedicled lateral intercostal artery perforator (LICAP) flap. This study evaluates the combination of a free abdominal flap and a pedicled LICAP flap to achieve increased breast size and improved cosmetic outcome.Methods:Patients undergoing secondary autologous breast reconstruction were included in a prospective study. The combination with a LICAP flap was used for women with insufficient abdominal flap tissue in relation to the desired breast size. The authors also assessed their modification of the original lateral thoracodorsal flap design to improve the aesthetic outcome.Results:In 109 patients, 121 free abdominal flaps were performed. The combination with a pedicled LICAP flap was used in 82 free abdominal flap reconstructions (68%). The LICAP flap provided additional volume and resulted in better projection and ptosis of the neo-mamma. The overall complication rate for the LICAP flaps was 26 %; all minor complications. Despite combining flaps, the majority of patients needed additional surgery to improve breast symmetry. Breast reduction of the native breast was the most common symmetrizing procedure.Conclusion:In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.

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“…Bipedicled DIEP flaps have also been described in several different compositions (Agarwal & Gottlieb, 2007;Beahm & Walton, 2007;Murray, Wasiak, Rozen, Ferris, & Grinsell, 2015;Salgarello, Barone-Adesi, Sturla, Masetti, & Mu, 2010).…”

Section: Introductionmentioning

confidence: 99%

“…Introducing a second vascular pedicle into the flap may enhance its perfusion to an additional volume of tissue included in the flap (Murray et al, 2015;Salgarello et al, 2010;Zelter, Andrades, & Hamdi, 2011). Bipedicled free flap uses two vascular pedicles (minimum of four microvascular anastomoses) to enable harvesting entire lower abdomen.…”

Section: Introductionmentioning

confidence: 99%

Unilateral autologous breast reconstruction with unipedicled and bipedicled deep inferior epigastric artery perforator flap: A review of 168 cases over 3 years

et al. 2020

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Background Harvesting a DIEP flap based on bipedicled perforators can enhance vascular perfusion, which can reduce complication rates, minimize fat necrosis, and flap failure. This study summarizes our experience with using unipedicled and bipedicled DIEP flaps for breast reconstruction. Patients and Methods A total of 168 consecutive patients undergoing unilateral breast reconstruction with DIEP flaps over a 3‐year period were retrospectively reviewed. Primary microvascular anastomoses were performed to the thoracodorsal vessels in both unipedicled and bipedicled DIEP groups. In bipedicled DIEP flap cases, additional secondary microvascular anastomoses were performed either by extraflap or intraflap options. Clinical characteristics and outcomes were recorded. Results Unipedicled (n = 89; 53%) and bipedicled flaps were used. Both groups were comparable for mean age, diabetes mellitus, hypertension, smoking, and chemotherapy. BMI was 24.9 ± 3.6 in the unipedicled group and 22.8 ± 2.9 in the bipedicled group (p < .001). The surgical duration was longer in bipedicled group (367 ± 86.5 minu vs 403.7 ± 65.6 min, p < .05) but incidence of fat necrosis decreased in the bipedicle group (24 patients [27%] vs. 7 patients [8.9%] p < .05). There was no flap loss or instance of abdominal hernia in any group. Conclusions The bipedicled DIEP flaps may be a feasible option for large breast reconstruction in thin patients. However, the additional microsurgical technical complexity and longer operative time must be considered.

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Needing a large DIEAP flap for unilateral breast reconstruction: Double‐pedicle flap and unipedicle flap with additional venous discharge

Cited by 11 publications

References 14 publications

Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

Use of the superficial inferior epigastric vein in breast reconstruction with a deep inferior epigastric artery perforator flap

The Pedicled LICAP Flap Combined with a Free Abdominal Flap In Autologous Breast Reconstructions

Unilateral autologous breast reconstruction with unipedicled and bipedicled deep inferior epigastric artery perforator flap: A review of 168 cases over 3 years

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