The transverse upper gracilis flap for breast reconstruction following liposuction of the thigh

Saint‐Cyr, Michel; Shirvani, Arash; Wong, Corrine

doi:10.1002/micr.20814

Cited by 7 publications

(3 citation statements)

References 18 publications

(23 reference statements)

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“…In the same year Harii et al reported the first gracilis free flap for reconstruction of the head and neck and lower extremity [35] . Since the late seventies the gracilis myocutaneous flap has been used for soft tissue reconstruction of the breasts [27] – [30] , [36] , [37] , head and neck [38] – [40] , upper and lower extremity [41] , [42] and the genitoperineal region [43] , [44] . It has also been used as a free functioning muscle transfer for restoration of elbow flexion [45] – [47] , dynamic analplasty [48] , [49] and facial reanimation [50] – [52] .…”

Section: Introductionmentioning

confidence: 99%

The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction

et al. 2012

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BackgroundMastectomies are one of the most common surgical procedures in women of the developed world. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. This study quantifies the fasciocutaneous vascular territories of the gracilis flap and offers the potential to reconstruct breasts of all sizes.MethodsTwenty-seven human cadaver dissections were performed and injected using lead oxide into the gracilis vascular pedicles, followed by radiographic studies to identify the muscular and fasciocutaneous perforator patterns. The vascular territories and choke zones were characterized quantitatively using the ‘Lymphatic Vessel Analysis Protocol’ (LVAP) plug-in for Image J® software.ResultsWe found a step-wise decrease in the average vessel density from the upper to middle and lower thirds of both the gracilis muscle and the overlying skin paddle with a significantly higher average vessel density in the skin compared to the muscle. The average vessel width was greater in the muscle. Distal to the main pedicle, there were either one (7/27 cases), two (14/27 cases) or three (6/27 cases) minor pedicles. The gracilis angiosome was T-shaped and the maximum cutaneous vascular territory for the main and first minor pedicle was 35×19 cm and 34×10 cm, respectively.ConclusionOur findings support the concept that small volume breast reconstructions can be performed on suitable patients, based on septocutaneous perforators from the minor pedicle without the need to harvest any muscle, further reducing donor site morbidity. For large reconstructions, if a ‘T’ or tri-lobed flap with an extended vertical component is needed, it is important to establish if three territories are present. Flap reliability and size may be optimized following computed tomographic angiography and surgical delay.

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Section: Introductionmentioning

confidence: 99%

The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction

et al. 2012

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“…The transverse upper gracilis (TUG) flap could be an indication for reconstruction of small or moderate breasts in women who do not want to have implants, when the abdomen is not an available donor site or who would not accept scars in the abdomen or in the gluteal region. The flap is based on a branch of the medial circumflex femoral artery [ 1 – 4 ]. The vascular pedicle is relatively short, but the flap dissection is quite fast.…”

Section: Introductionmentioning

confidence: 99%

Double Free Transverse Upper Gracilis Flap Breast Reconstruction: Advantages of Using LD Flap as a Salvage Solution

et al. 2021

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The lower abdominal tissue is still the most common donor site used for free autologous breast reconstruction. If this site is not available, multiple secondary choices exist. The transverse upper gracilis flap is a valuable choice and it can be used alone or in combination with other flaps. We present a case of a 49-year-old patient who underwent delayed unilateral breast reconstruction by using a double transverse upper gracilis flap. Due to venous thrombosis, the flap inserted in the lower pole was lost. We managed the complication tailoring a latissimus dorsi flap to close the defect. We reported the advantages of the latissimus dorsi flap as a rescue solution and its superior aesthetic result in this particular case. Breast reconstruction with transverse upper gracilis flap in addition to the latissimus dorsi flap allowed us to obtain an adequate breast volume avoiding the use of breast implants as desired by the patient. We thought that the double free transverse upper gracilis flap for delayed, or immediate unilateral reconstruction of small to moderate breast could be a valuable option to avoid the use of implants and when abdominal tissue is not available. However, it should be taken into consideration the shortness of the transverse upper gracilis pedicle, the necessity to perform a retrograde flow anastomosis at the level of the internal mammary, and the discrepancy of skin color tones with the receiving site. The latissimus dorsi flap was an excellent rescue solution and put in evidence the aesthetic superiority of this flap compared to the transverse upper gracilis flap.

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“…[3][4][5][6][7][8][9][10] Some surgeons have proposed alternate flap designs to circumvent these concerns including bipedicled flaps, 5 while others recommend avoiding the abdomen altogether and moving to a less common donor site such as gluteal flaps 7 or the transverse upper gracilis flap. 11 Given that liposuction is one of the most frequently performed aesthetic procedures in western countries, 12 and has become a commonly used adjunctive procedure in patient who have undergone alloplastic breast reconstruction, it is imperative to understand whether these concerns are valid in this group of patients desiring autologous breast reconstruction. Therefore, this review aims to explore the total published literature on the outcomes of abdominally based breast reconstruction in patients with a history of abdominal liposuction.…”

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confidence: 99%

The Impact of Abdominal Liposuction on Abdominally Based Autologous Breast Reconstruction: A Systematic Review

2022

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Prior abdominal liposuction can be viewed as a relative or absolute contraindication to abdominally based autologous breast reconstruction given concerns for damaged perforators and scarring complicating intraoperative dissection. This systematic review aims to explore the outcomes of abdominally based breast reconstruction in patients with a history of abdominal liposuction. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guided literature search was conducted using PubMed, Scopus, and Web of Science from the earliest available date through June 2020. Deep inferior epigastric perforator, muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), superficial inferior epigastric artery, and pedicled TRAM flaps were included for evaluation. Complications included total or partial flap loss, fat necrosis, seroma, delayed wound healing, and donor site complications. After inclusion criteria were applied, 336 nonduplicate articles were screened, yielding 11 for final review, representing 55 flaps in 43 patients. There was no instance of total flap loss, eight (14.5%) flaps developed partial loss or fat necrosis, three (5.4%) flaps had delayed wound healing, and two (4.6%) patients had donor site complications. Most authors (8/11) utilized some type of preoperative imaging. Doppler ultrasonography was the most used modality, and these patients had the lowest rate of partial flap loss or flap fat necrosis (8%), followed by those without any preoperative imaging (10%). In conclusion, this review supports that patients undergoing abdominally based autologous breast reconstruction with a history of abdominal liposuction are not at an increased risk of flap or donor site complications. Although preoperative imaging was common, it did not reliably decrease complications. Further prospective studies are needed to address the role of imaging in improving outcomes.

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The transverse upper gracilis flap for breast reconstruction following liposuction of the thigh

Cited by 7 publications

References 18 publications

The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction

The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction

Double Free Transverse Upper Gracilis Flap Breast Reconstruction: Advantages of Using LD Flap as a Salvage Solution

The Impact of Abdominal Liposuction on Abdominally Based Autologous Breast Reconstruction: A Systematic Review

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