Alternative flaps in autologous breast reconstruction

Myers, Paige L.; Nelson, Jonas A.; Allen, Robert J.

doi:10.21037/gs.2020.03.16

Cited by 31 publications

(35 citation statements)

References 75 publications

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“…The dissection of the vPAP will not be as anterior and has a higher chance of sparing the lymphatic drainage. 20,21 We found that the dominant perforator is located at a mean distance of 1.98 and 1.26 cm (on imaging and cadaveric dissection, respectively) from the posterior border of the gracilis. Furthermore, distal perforators were found in a slightly more anterior location, suggesting that vertical flap design may be shifted slightly anteriorly when centered on these vessels.…”

Section: Discussionmentioning

confidence: 81%

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Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Artz

Atamian

Mulloy

et al. 2021

J Reconstr Microsurg

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Introduction While the originally described transverse profunda artery perforator (tPAP) flap is designed to capture the first profunda perforator, our group hypothesized the dominant perforator may not always be captured in this configuration. This study maps the location of dominant profunda perforators using imaging and cadaveric dissections to determine the probability of capturing dominant perforators with the transverse flap design versus the vertical PAP (vPAP) variant. Methods Fifty preoperative magnetic resonance angiogram or computed tomographic angiogram scans (100 total extremities) were examined from autologous breast reconstruction patients between 2015 and 2019. Profunda perforator characteristics that were examined included the distance from the pubic tubercle to the infragluteal fold (IGF), the distance of the perforators from the IGF, distance posterior to the gracilis, the diameter of the perforator at fascial exit, and total number of perforators present. Profunda perforator dissection was performed in 18 cadaveric extremities. Analysis included mean distance from pubic tubercle, distance posterior to the gracilis, diameter at fascial exit, and total number of perforators. Results In imaging analysis, the mean distance from the IGF to the fascial exit of all dominant perforators was 7.04 cm. The mean diameter of the dominant perforator at the fascial exit was 2.61 mm. Twenty-six thighs (26%) demonstrated dominant perforators that exited the fascia greater than 8 cm below the IGF. In cadaver dissections, the mean distance from the pubic tubercle to the fascial exit of all the dominant perforators was 10.17 cm. Nine cadaver specimens (50%) demonstrated perforators that exited the fascia greater than 8 cm below the estimated IGF. Conclusion The dominant perforator can often be missed in the traditional tPAP design. The vPAP incorporates multiple perforators with a long pedicle, excellent vessel diameter, and favorable donor-site.

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Section: Discussionmentioning

confidence: 81%

“…The dissection of the vPAP will not be as anterior and has a higher chance of sparing the lymphatic drainage. 20 21…”

Section: Discussionmentioning

confidence: 99%

Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Artz

Atamian

Mulloy

et al. 2021

J Reconstr Microsurg

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“…Compared to other popular and most commonly used alternatives to the DIEP flap for autologous breast reconstruction such as the lumbar artery perforator (LAP) flap, the superior gluteal artery perforator (SGAP) flap or the fasciocutaneous infragluteal free flap (FCI) flap, the TMG flap offers a comparable size and a similar complication profile, the mean pedicle length is significantly shorter though [36][37][38]. An overview of the common used free flaps and their detailed characteristics is shown in Table 5 [21,23,34,39,40].…”

Section: Discussionmentioning

confidence: 99%

Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

Weitgasser

Mahrhofer

Schwaiger

et al. 2021

JCM

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Background: Happy 30th birthday to the transverse myocutaneous gracilis (TMG) flap. Since 1991 the TMG flap has been used to reconstruct a wide variety of defects and became a workhorse flap and reliable alternative to the deep inferior epigastric perforator (DIEP) flap in many breast reconstruction services worldwide. This manuscript sheds light on the history and success of the TMG flap by critically reviewing the present literature and a series of 300 patients receiving a breast reconstruction. Patients and Methods: The present literature and history of the TMG flap was reviewed and a retrospective double center cohort study of 300 free TMG free flaps for autologous breast reconstruction was conducted. Patient demographics, perioperative data, and post-operative complications were recorded and compared with literature findings. Results: Mean flap weight was 320 g. Mean pedicle length was 70 mm. Complications included 19 (6.3%) flap loss. 10 patients (3.3%) had postoperative cellulitis and 28 (9.3%) wound healing disturbance of the donor site. Conclusion: Recipient and donor site complications were comparable to other free flaps used for breast reconstruction. A low BMI or the lack of an abdominal based donor site do not represent a limitation for breast reconstruction and can be overcome using the TMG flap.

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“…The gold standard for autologous reconstruction in the post-mastectomy patient remains the DIEAP flap, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options on the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap) and trunk (lumbar artery perforator flap, superior and inferior gluteal artery perforator flaps) [ 38 ], [ 39 ].…”

Section: Autologous Breast Reconstructionmentioning

confidence: 99%

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

Al-Benna

Gohritz

2021

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Alternative flaps in autologous breast reconstruction

Cited by 31 publications

References 75 publications

Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Use of the Vertical Profunda Artery Perforator Flap to Capture the Dominant Perforator: A Cadaver Dissection and Imaging Study

Lessons Learned from 30 Years of Transverse Myocutaneous Gracilis Flap Breast Reconstruction: Historical Appraisal and Review of the Present Literature and 300 Cases

Breast reconstruction during the COVID-19 pandemic in resource-limited settings

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