Preserving the Internal Mammary Artery

Apostolides, John G.; Magarakis, Michael; Rosson, Gedge D.

doi:10.1097/prs.0b013e31821740ff

Cited by 29 publications

(7 citation statements)

References 27 publications

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“…1 As SNB has become commonly used, the TDA/V are not favored because of the invasive and time-consuming process. [7][8][9] In contrast, the IMA/V have gained popularity following reports on the use of the ribsparing technique, 16,20 end-to-side anastomosis, 18,21 anastomosis to internal mammary vessel perforator, [22][23][24] and flow-through anastomosis 25 to address problems. However, axillary vessels such as the TDA/V are important because reconstruction can be performed with only a lateral incision without creating a conspicuous anterior scar.…”

Section: Discussionmentioning

confidence: 99%

Lateral Thoracic Vessel as a Recipient Vessel in Immediate Breast Reconstruction after Nipple/Skin-Sparing Mastectomy: Clinical Experience of 270 Perforator Flaps

Muto

Satake

Tsunoda

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: The selection of recipient vessels for free-flap breast reconstruction is important for the success of the surgery and the aesthetics of the breast mound. The thoracodorsal artery and vein (TDA/V) allow reconstruction without noticeable scars from the anterior view, but TDA/V exposure is an invasive and time-consuming process on sentinel node biopsy. This study aimed to determine the effectiveness of the lateral thoracic artery and vein (LTA/V) as recipient vessels by comparing them with the TDA/V. Methods: This study included 270 flaps that underwent immediate free-flap breast reconstruction after nipple/skin-sparing mastectomy by lateral incision. The patients were categorized into two groups (LTA and TDA) based on the recipient vessel selected. Results: The LTA and TDA groups comprised 78 and 192 flaps, respectively. Among the 131 short and small pedicle flaps, such as gluteal artery perforator flap and profunda artery perforator flap, 65 (50%) used the LTA as the recipient vessel. The external diameters of the LTA/LTV (median, 1.2 mm/1.5 mm) were significantly lower than those of the TDA/TDV (median, 1.65 mm/2.0 mm). The LTV was present in 94%, and the second vein was present in 49% of cases with anastomosis. No significant differences in flap-related complications were observed between the two groups. Conclusions: The LTA/V can be used as recipient vessels for immediate free-flap reconstruction. Because of their superficial location and small caliber, they are easily accessible and suitable for short and small pedicle flaps. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Section: Discussionmentioning

confidence: 99%

Lateral Thoracic Vessel as a Recipient Vessel in Immediate Breast Reconstruction after Nipple/Skin-Sparing Mastectomy: Clinical Experience of 270 Perforator Flaps

Muto

Satake

Tsunoda

et al. 2023

Plastic &Amp; Reconstructive Surgery

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“…However, cadaveric studies may be unreliable due to the lack of pulsation and the presence of vascular contraction. Clinical studies have reported average external diameter of arterial perforators being 1.32–1.52 mm and venous perforator diameter being 1.4–2.2 mm (Apostolides et al, 2011; Arnez et al, 1995; Baek et al, 2013; Dupin et al, 1996; Fansa et al, 2013; Follmar et al, 2011; Guzzetti & Thione, 2001; Haywood et al, 2003; Kanoi et al, 2017; Ninković et al, 1995; Park et al, 2003; Rosson et al, 2005; Saint‐Cyr et al, 2007; Saour et al, 2017; Schmidt et al, 2010; Vesely et al, 2007). The largest arterial and venous perforator diameter reported were 2.5 and 2.2 mm, respectively (Baek et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Utilization of the internal mammary perforators as the recipient vessels for microsurgical breast reconstruction: A systematic review and meta‐analysis of the literature

Vourvachis,

Goodarzi,

Scaglioni

et al. 2023

Microsurgery

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BackgroundThe selection of reliable recipient vessels is essential for successful free tissue transfer. The use of internal mammary intercostal perforators (IMAPs), instead of the internal mammary vessels as the recipient vessels, has been described in breast reconstruction. Debates exist regarding the reliability of these perforators as recipient vessels because of their variability in location and caliber. The aim of this paper was to conduct a systematic literature review and meta‐analysis to determine the reliability of the IMAPs as recipient vessels.MethodsA systematic literature review was performed on the “PubMed,” “Medline,” “Ovid,” and “Cochrane library” databases for articles published from January 1990 to March 2021. Exclusion criteria were non‐English studies, reports with case number less than 5, cadaveric or animal studies, and studies with incomplete postoperative outcomes. The reliability of using IMAPs for breast reconstruction was determined by assessing the reported rates of partial or complete flap failure and other complications (fat necrosis, skin necrosis, and requirement for revision surgery).ResultsThree hundred and sixteen cases in 13 studies were included for further analysis with more than 85% of the IMAPs suitable for anastomosis being located in the second and third intercostal spaces. Partial or total flap failure was reported in three of 316 patients (0.95%). The rate of other complications such as fat necrosis, skin necrosis, and requirement for revision surgery were all less than 5%.ConclusionWith deliberate preoperative planning, delicate perioperative manipulation, and meticulous microvascular anastomosis, the internal mammary perforators can be used as reliable recipient vessels in microvascular breast reconstruction.

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“…Predictably, the failure rates documented in these studies are far higher than in breast reconstruction using ETS arterial anastomoses. 54,55 The variability of results between these large studies using the one anastomosis technique demonstrates many factors at play in free flap success rates. More broadly, Cho et al’s 53 findings are supported by clinical evidence showing equivalent long-term patency rates for ETE and ETS anastomoses in free tissue transfer to various anatomic sites.…”

Section: Discussionmentioning

confidence: 99%

End-to-side Anastomosis on Digital Arteries: Just a Technical Choice or a Real Benefit?

Troisi

Clemente

Susca

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: High-quality evidence is currently poor regarding the benefits of end-to-end (ETE) or end-to-side (ETS) anastomosis in arterial and venous anastomoses, despite being postulated as a potential influence on outcomes. A sufficient microvascular anastomosis is indispensable for the success of any free tissue transfer. ETS microvascular anastomoses have been becoming increasingly important as they allow reconstruction even in patients with impaired vascular status. To the authors’ knowledge, no studies have examined the choice of ETE or ETS anastomoses specifically for digital arteries. Methods: We conducted a retrospective study of ETE and ETS anastomosis cases; the only inclusion criteria was that digital arteries (proper, common) were the recipient vessels. Results: Fifty-seven cases met the inclusion criteria. All the venous anastomoses were ETE. Of these cases, four total intraoperative complications (immediate thrombosis) and only one case of complete failure were registered. The ETE group consisted of 49 patients and the ETS group of eight patients. A comparison of the mean ischemia time in the two groups showed no statistically significant difference (P = 0.121). Conclusions: We observed no difference in the reconstructive outcomes of hand free-flaps and reconstruction between ETE or ETS digital arteries anastomoses. The successful microsurgical reconstruction was independent of anastomotic technique. In particular, the results of our study demonstrated no statistically significant increase of the ischemia time; thus, no prolongation of operative time can be attributed to the higher technical challenge of the anastomosis.

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Preserving the Internal Mammary Artery

Abstract: Therapeutic, III.

Cited by 29 publications

References 27 publications

Lateral Thoracic Vessel as a Recipient Vessel in Immediate Breast Reconstruction after Nipple/Skin-Sparing Mastectomy: Clinical Experience of 270 Perforator Flaps

Lateral Thoracic Vessel as a Recipient Vessel in Immediate Breast Reconstruction after Nipple/Skin-Sparing Mastectomy: Clinical Experience of 270 Perforator Flaps

Utilization of the internal mammary perforators as the recipient vessels for microsurgical breast reconstruction: A systematic review and meta‐analysis of the literature

End-to-side Anastomosis on Digital Arteries: Just a Technical Choice or a Real Benefit?

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