No abstract

The deep inferior epigastric artery perforator (DIEP) flap has recently become the first option for breast reconstruction. However, the anatomy of the deep inferior epigastric artery varies greatly from one individual to another and even from one hemiabdomen to the other. An optimal pre-operative evaluation method that adequately maps the underlying vasculature has been lacking. The advent of multidetector-row CT (MDCT) angiography has proven highly accurate at detailing the vasculature, but no reports have documented its value during pre-operative planning. From December 2006 to May 2008, 22 consecutive patients who underwent MDCT angiography before breast reconstruction using DIEP flaps were selected as the test group, and 22 former patients who did not undergo MDCT before the same procedure were selected as the control group. The two groups were evaluated for the ratio of pre-operative redesign, intra-operative method changes, time spent on flap harvest and the ratio of flap-associated complications. The pre-operative redesign ratio was 22.7% in the test group and 0% in the control group. The intra-operative method change ratio was 0% in the test group and 13.6% in the control group. The mean time spent on flap harvest was 2.8 +/- 0.2 h in the test group and 4.4 +/- 0.2 h in the control group (p<0.05). The flap complication rate was 1/22 in the test group and 3/22 in the control group (p _ 0.04). In conclusion, use of MDCT angiography during pre-operative planning promotes a significant reduction in operating time and complication rate.

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The transplantation of abdominal flap with vascularized lymph node and breast reconstruction, accompanied by the treatment to upper limb lymphedema and using elastic bandages as an adjuvant therapy, is considered to be an effective method to restore the configuration and function of breasts. Long-term follow-up visits are undergoing, especially the lymphoscintigraphy, 2 years after the operation.

The authors show convincing evidence for dynamic changes of stromal vascular fraction cells after co-implantation with fat grafts. The results prove the principle that implanted stromal vascular fraction cells can survive in the ischemic microenvironment of fat grafts and participate in the process of adipogenesis and angiogenesis.