The ???Perfusion Map??? of the Unipedicled TRAM Flap to Reduce Postoperative Partial Necrosis

Yamaguchi, Satoru; Lorenzi, Francesca De; Petit, Jean Yves; Rietjens, Mario; Garusi, Cristina; Giraldo, Alejandro Chaparro; Rey, Piercarlo; Úrban, Cícero; Martella, Stefano; Bosco, Riccardo

doi:10.1097/01.sap.0000116284.51679.ea

Cited by 62 publications

(63 citation statements)

References 15 publications

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“…Recent studies have shown a better vascularization in zone III when compared with zone II. 2,13,14 By measuring of the external diameter of the perforators branches in the flap tissue, we wanted to confirm this, and more precisely determine which parts of the respective zones have a better arterial network. We have determined the median sum of the external diameters of the perforator branches of zones II and III as well as their parts.…”

Section: Discussionmentioning

confidence: 99%

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Deep inferior epigastric perforator flap: An anatomical study of the perforators and local vascular differences

et al. 2011

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The objective of this study was to determine precise localization and external diameter of the lower abdominal wall perforators as well as to investigate some vascularity differences between the same parts of perfusion zones II and III according to Hartrampf perfusion zones. The study was performed on 10 fresh cadavers (20 hemiabdomens) using the gelatin injection technique. All perforators were identified, and their localization and diameter were noted. Measurements were made at the level of the fascia. We noted localization and diameter of arteries on cross-sectional planes of either part of the flap. The median sum of the external diameter of all arteries in zone I was 17.01 mm. The median sum of the external diameter of all arteries in the medial 1/3 part of zone III was 4.17 mm, and in the medial 1/3 part of zone II, it was 0.96 mm. The median sum of the external diameter of all arteries in the intermediary 1/3 part of zone III was 2.16 mm, whereas in the intermediary 1/3 part of zone II, it was 0.81 mm. Significant differences were recorded between proximal and middle horizontal regions of zones II and III and between medial vertical part of zone III and medial vertical part of zone II. Anastomoses between zones I and II are considerably smaller compared with anastomoses between zones I and III. The best vascularized parts of the lower abdominal wall were perfusion zone I, then the inner 2/3 of zone III and medial 1/3 of zone II.

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Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Some recent studies investigated correctness of zones II and III localization. 2,13,14 The objective of this study was to determine precise localization and external diameter of the lower abdominal wall perforators as well as to investigate some vascularity differences between the same parts of perfusion zones II and III.…”

mentioning

confidence: 99%

Deep inferior epigastric perforator flap: An anatomical study of the perforators and local vascular differences

et al. 2011

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“…The use of Doppler flow analysis demonstrated support for a switch of the conventional Zones II and III (Hallock, 2001). A more recent modality has been the use of indocyanine green dye, detectable with fluorescence videoangiography (Yamaguchi et al, 2004;Holm et al, 2006). This technique for the assessment of perfusion has also demonstrated support for a change in the classification of perfusion zones.…”

Section: Perfusion Zones (Angiosomes) Of the Anterior Abdominal Wallmentioning

confidence: 96%

Reviewing the vascular supply of the anterior abdominal wall: Redefining anatomy for increasingly refined surgery

2008

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The abdominal wall integument is becoming the standard donor tissue for postmastectomy breast reconstruction, with its vascular supply of key importance to the reconstructive surgeon. Refinements in tissue transfer, from pedicled to free flaps and musculocutaneous to perforator flaps, have required increasing understanding of finer levels of this vascular anatomy. The widespread utilization of the deep inferior epigastric artery (DIEA) perforator flap, particularly for breast reconstruction, has rekindled clinical interest in further levels of anatomical detail, in particular the location and course of the musculocutaneous perforators of the DIEA. Advances in operative techniques, and anatomical and imaging technologies, have facilitated an increase in this understanding. The current review comprises an appraisal of both the anatomical and clinical literature, with a view to highlighting the key anatomical features of the abdominal wall vasculature as related to reconstructive flaps.

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“…In the past, intraoperative catheter angiography has been used as a method for assessing flap perfusion intraoperatively (Taylor and Palmer, 1987;Taylor et al, 1991;Taylor, 1999). Other methods used with success have included the use of indocyanine green and other fluorescing agents (Holm et al, 2002;Yamaguchi et al, 2004).…”

Section: Introductionmentioning

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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The ???Perfusion Map??? of the Unipedicled TRAM Flap to Reduce Postoperative Partial Necrosis

Cited by 62 publications

References 15 publications

Deep inferior epigastric perforator flap: An anatomical study of the perforators and local vascular differences

Deep inferior epigastric perforator flap: An anatomical study of the perforators and local vascular differences

Reviewing the vascular supply of the anterior abdominal wall: Redefining anatomy for increasingly refined surgery

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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