Planning and optimising DIEP flaps with virtual surgery: the Navarra experience

Rozen, Warren M.; García-Tutor, Emilio; Alonso‐Burgos, Alberto; Acosta, Rafael; Stillaert, Filip; Jl, Zubieta; Hamdi, Moustapha; Whitaker, Iain S.; Ashton, Mark W.

doi:10.1016/j.bjps.2008.10.007

Cited by 77 publications

(61 citation statements)

References 30 publications

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“…For the deep inferior epigastric artery (DIEA) perforator (DIEP) flap for example, computed tomographic angiography (CTA) has become widely used to map both the arterial and venous anatomy of the abdominal wall, including the presence, size and course of DIEA perforators, and the dominance of superficial or deep venous systems in the venous drainage of the flap [7,9]. In fact, this imaging can aid in the selection of the hemi-abdominal wall of choice, the perforator of choice and map all features of surgical dissection as 'virtual surgery'.…”

Section: Introductionmentioning

confidence: 99%

Mapping the vascular anatomy of free transplanted soft tissue flaps with computed tomographic angiography

et al. 2011

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Section: Introductionmentioning

confidence: 99%

Mapping the vascular anatomy of free transplanted soft tissue flaps with computed tomographic angiography

et al. 2011

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“…These communications (Boscillating veins^between the adjacent venous territories) [15] may be the limiting factor to venous drainage. The use of preoperative imaging to demonstrate the presence and calibre of these communications may be a useful tool for aiding perforator selection and for maximizing venous outflow [20]. As such, an SIEV greater than 1.5 mm in diameter can be considered a dominant superficial system vein, and a perforating vein greater than 1 mm in diameter is a dominant DIEV perforator.…”

Section: Discussionmentioning

confidence: 98%

Novel use of the superficial inferior epigastric vein lifeboat in DIEP flap harvest

2015

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Deep inferior epigastric artery perforator (DIEP) flap reconstruction has become a well-established procedure for breast reconstruction. While vascular compromise is not common, venous congestion is the most commonly reported cause of such compromise, and of those that may require reexploration, insufficient venous drainage is the most common cause. In such cases, flap salvage may require establishment of a secondary venous outflow source. In a standard unilateral breast reconstruction with a DIEP flap, zone IV is discarded, with the intra-flap segment of the superficial inferior epigastric vein (SIEV) unused. We describe the novel approach of harvesting the SIEV within zone IVand banking within the breast pocket near the contralateral superficial vein should it be required for further salvage surgery. Our approach involves harvest of the SIEV on a side table (which allows simultaneous operating), flushing the graft with heparinized saline, and tagging the proximal end with an 8/0 nylon suture. This vein graft is then transferred and banked at the breast recipient site, near the flap vein where it is likely to be required. This simple step prevents further morbidity of a secondary donor site and reduces operative time should re-exploration be required. Level of Evidence: Level V, therapeutic study

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“…This study has expanded that analysis to include a wide range of surgical scars, particularly those seen in the cohort of patients undergoing lower abdominal flaps for breast reconstruction. Although CTA has become increasingly utilized prior to all cases of perforator flap surgery, as a tool to evaluating ''normal'' individual variability and anatomical variation (Rozen et al, 2008c), this study has shown that variation may be even more pronounced in cases of previous surgery. Although CTA is associated with radiation exposure and a risk of uncommon complications, it has been shown in multiple international studies to significantly improve operative outcomes in abdominal free flap surgery (Rozen et al, 2008a;Smit et al, 2008;Uppal et al, 2008;Casey et al, 2009), and this paper further contributes to these benefits.…”

Section: Discussionmentioning

confidence: 99%

The effect of anterior abdominal wall scars on the vascular anatomy of the abdominal wall: A cadaveric and clinical study with clinical implications

et al. 2009

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The anterior abdominal wall integument is frequently used in a range of reconstructive flaps. These tissues are supplied by the deep and superficial inferior epigastric arteries (DIEA and SIEAs) and the deep and superficial superior epigastric arteries (DSEA and SSEAs). Previous abdominal wall surgery alters this vascular anatomy and may influence flap design. One hundred and sixty-eight patients underwent abdominal wall computed tomographic angiography (CTA) for preoperative imaging. Fifty-eight of these patients had undergone previous abdominal surgery, and were assessed for scar pattern and relationship to the course and distribution of all major axial vessels and perforators. Two cadaveric abdominal wall specimens with midline abdominal scars underwent contrast injection of the DIEAs and DSEAs, with subsequent CTA. The course and distribution of all cutaneous vessels were assessed. In all clinical and cadaveric cases, the vasculature of the abdominal wall had been altered by previous surgery. In the clinical cases, vascular architecture was universally altered in the region of the scar, often modifying the filling patterns of the abdominal wall and occasionally precluding the use of an abdominal wall flap. In both cadaveric specimens, regions of non-filling were evident upon contrast injection, highlighting the angiosomes not supplied by the DIEA or DSEA. Previous abdominal wall surgery necessarily alters the vascular architecture of the abdominal wall, and may alter the source vessels supplying cutaneous tissues. CTA was useful in identifying and delineating these changes, and may be used as a preoperative tool in this role.

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Planning and optimising DIEP flaps with virtual surgery: the Navarra experience

Cited by 77 publications

References 30 publications

Mapping the vascular anatomy of free transplanted soft tissue flaps with computed tomographic angiography

Mapping the vascular anatomy of free transplanted soft tissue flaps with computed tomographic angiography

Novel use of the superficial inferior epigastric vein lifeboat in DIEP flap harvest

The effect of anterior abdominal wall scars on the vascular anatomy of the abdominal wall: A cadaveric and clinical study with clinical implications

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