The Role of Measurement of Pedicle Length for DIEP Flap Transferring in Breast Reconstruction

Song, Dajiang; Pafitanis, Georgios; Li, Juanjuan; Li, Zan

doi:10.1097/sap.0000000000002978

Cited by 3 publications

(2 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This assumption could be supported by the finding that the actual length of the harvested pedicle was similar to the value measured on CTA in the short-fasciotomy group. Furthermore, the pedicle length of cohort 2 showing 12.5 cm, on average, was comparable to those reported in previous studies, 12 and sufficed to reach the second intercostal space 24 for microvascular anastomosis in most cases. Also, there were no cases where surgeons had difficulty in technical performance of microanastomosis because of pedicle length shortage in cohort 2.…”

Section: Discussionsupporting

confidence: 85%

Short Fasciotomy-Deep Inferior Epigastric Perforator Flap Harvest for Breast Reconstruction

Kim

Lee

Mun³

2023

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

Since Hartrampf et al. described the pedicled transverse rectus abdominis musculocutaneous flap, 1 abdominally based breast reconstruction has evolved to conserve the donor-site tissue, including the rectus abdominis muscle and fascia, to extricate patients from risks of serious donor morbidities, such as abdominal wall weakness or hernia. Consequently, the deep inferior epigastric artery perforator (DIEP) flap was proposed, 2 showing significantly reduced donor-site complications compared with traditional transverse rectus abdominis musculocutaneous flaps. 3,4 It has served as the main modality for autologous breast reconstruction.Although the entire rectus muscle and fascia are left in the donor site, postoperative bulging or hernia still develops following harvest of the DIEP flaps, with a reported incidence of approximately 3% to 5%. 4,5 It is suggested to be attributable to unavoidable violation of abdominal rectus fascia Background: Despite several technical modifications to further reduce donor invasiveness in harvesting deep inferior epigastric perforator (DIEP) flaps, techniques with general applicability and demonstrating clinical benefits are scarce. The present study aimed to introduce a short-fasciotomy technique and evaluate its reliability, efficacy, and applicability by comparison with those of conventional methods. Methods: A retrospective study was conducted with 304 consecutive patients who underwent DIEP flap-based breast reconstruction. A total of 180 patients underwent the conventional technique between October of 2015 and December of 2018 (cohort 1), and in 124 patients, the short-fasciotomy technique was implemented between January of 2019 and September of 2021 (cohort 2). In the short-fasciotomy technique, the rectus fascia was incised as much as overlies the intramuscular course of targeted perforators. After intramuscular dissection, pedicle dissection proceeded without additional fasciotomy. Postoperative complications and fasciotomy-saving benefits were compared. Results: The short-fasciotomy technique was successfully adapted for all patients in cohort 2, regardless of length of intramuscular course and number of harvested perforators, with no case requiring conversion to the conventional technique. The mean fasciotomy incision length in cohort 2 was 6.6 cm, which was significantly shorter than that in cohort 1 (11.1 cm). The mean length of the harvested pedicle in cohort 2 was 12.6 cm. No flap loss occurred in either group. The rate of other perfusion-related complications did not differ between the two groups. The rate of abdominal bulge/hernia was significantly lower in cohort 2. Conclusions: The short-fasciotomy technique allows for less invasive DIEP flap harvest regardless of anatomical variability. It provides reliable outcomes with minimal functional donor-site morbidity.

show abstract

Section: Discussionsupporting

confidence: 85%

Short Fasciotomy-Deep Inferior Epigastric Perforator Flap Harvest for Breast Reconstruction

Kim

Lee

Mun³

2023

Plastic &Amp; Reconstructive Surgery

View full text Add to dashboard Cite

show abstract

“…• Preoperative imaging versus no preoperative imaging and different types of preoperative imaging [57][58][59][60] • Different regimes for pedicle length [61] • Internal mammary vessels versus thoracodorsal vessels as recipient vessels [62] Pedicled flaps…”

Section: Implant-based Breast Reconstructionmentioning

confidence: 99%

A systematic review of randomised controlled trials in breast reconstruction

Hansson,

Larsson,

Uusimäki

et al. 2024

JPHS

View full text Add to dashboard Cite

Background: For preference sensitive treatments, such as breast reconstructions, there are barriers to conducting randomised controlled trials (RCTs). The primary aims of this systematic review were to investigate what type of research questions are explored by RCTs in breast reconstruction, where have they been performed and where have they been published, and to thematise the research questions and thus create an overview of the state of the research field. Methods: Randomised controlled trials investigating any aspect of breast reconstructions were included. The PubMed database was searched with a pre-defined search string. Inclusion and data abstraction was performed in a pre-defined standardised fashion. For the purpose of this study, we defined key issues as comparison of categories of breast reconstruction and comparison of immediate and delayed breast reconstruction, when the thematisation was done. Results: A total of 419 abstracts were retrieved from the search. Of the 419, 310 were excluded as they were not RCTs concerning some aspect of breast reconstruction, which left us with 110 abstracts to be included in the study. The research questions of the included studies could more or less be divided into seven different themes inclusive of 2 key issues: Other issues – comparison of different categories of breast reconstruction, comparison of immediate and delayed breast reconstruction, surgical details within a category of breast reconstruction, surgical details valid for several categories of breast reconstruction, donor site management, anaesthetics, and non-surgical details. Only five studies compared key issues, and they all illustrate the challenges with RCTs in breast reconstruction. Conclusions: A total of 110 publications based on RCTs in breast reconstruction have been published. Seven themes of research questions could be identified. Only five studies have explored the key issues. Better scientific evidence is needed for the key issues in breast reconstruction, for example by implementing a new study design in the field.

show abstract