The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace rib-sparing internal mammary vessel exposure

Abstract

Being able to predict patients with a small ICD in whom microsurgery may be more challenging can influence surgical planning. The anatomy of the intercostal spaces is variable and was not predictable in relation to height, BMI, or age. Height was not a reliable proxy for ICD and where there is a concern about the available ICD it is suggested that it is measured directly through preoperative imaging. This study found no increase in the complication rate and flap ischemia time using the rib-sparing IMV exposure technique.

Letter to the editor: applications of rib sparing technique in internal mammary vessels exposure of abdominal free flap breast reconstructions: a 12-year single-center experience of 215 cases

“…As detailed in our series, rib preserving IMV exposure is a safe technique with an overall flap success of 99.7% and an incredibly low re-exploration rate of 4.0% (2). However, contrary to the findings of Zhang et al in which the rib sparing group of patients were taller and with a wider ICS suggesting a correlation between patient's height and ICS, in our experience there was no such correlation between intercostal distance and patient height, age, BMI or flap ischaemia time (6). We have also previously documented the beneficial effect of rib preservation IMV exposure on early postoperative pain (7).…”

Total ‘rib’-preservation technique of internal mammary vessel exposure for free flap breast reconstruction: A 5-year prospective cohort study and instructional video

“…This could potentially lead to an increase in the ischaemia time, particularly with trainees or established surgeons switching to the ‘rib’-preservation technique. However, studies have not found a statistically significant difference in flap ischaemia times when comparing ‘rib’-preserving and ‘rib’-sacrificing microsurgical breast reconstructions [20,27] . In addition, our results show there was no statistically significant difference in intercostal space distance in those patients who underwent a re-exploration compared to those that did not ( Fig.…”

“…'s study which consisted mainly of Asian patients [31] who in general have smaller builds than Caucasian patients. Patient stature (or height) is, however, not a reliable proxy for intercostal space distance [27] .…”

Patient Height, Weight, BMI and Age as Predictors of Gracilis Muscle Free-Flap Mass in Lower Extremity Reconstruction

“…This study suggested patient height, weight, BMI and age as proxy measurements for gracilis muscle mass according to a similar investigation performed in the field of microsurgery (15), and to the knowledge available in the field of forensic anthropology, which elaborated formulae to estimate height from anthropometric data such as long bone length (femur/tibia/humerus), assuming that skeletal relationships are proportional (15)(16)(17)(18). We were, indeed, able to confirm from our group of patients the assumption that taller patients, with higher BMI, tend to have higher gracilis muscle mass, with a moderate correlation.…”