An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars – results from a single surgeon's experience

Hsieh, F.; Kumiponjera, Devor; Malata, Charles M.

doi:10.1016/j.bjps.2008.08.009

Cited by 37 publications

(33 citation statements)

References 51 publications

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“…11,15 Unlike previous studies, our donor site morbidity was similar in both groups (P = 0.5). Using our algorithm, we adjusted our flap design and/or harvest technique based on the specific abdominal scar.…”

Section: Discussioncontrasting

confidence: 82%

“…Previously, the free TRAM has been reviewed for its complication rate in the presence of abdominal scars. [8][9][10][11][12][13][14][15] The reviews are mixed, but overall, the studies showed the free TRAM was felt to have minimal complications when harvested in the presence of abdominal scars. However, in some studies, there was an increased risk of partial flap loss and fat necrosis.…”

Section: Discussionmentioning

confidence: 94%

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Algorithmic Approach to the Design and Harvest of Abdominal Flaps for Microvascular Breast Reconstruction in Patients With Abdominal Scars

Nykiel

Hunter

Lee

2015

Annals of Plastic Surgery

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Abdominal scars increase the risk of complications to the free flap. Unlike previous studies, patients with abdominal scars do not appear to have a statistically significant increase for donor site complications. Using the data from our study, we developed an algorithm for abdominal flap harvest in patients with abdominal scars. The algorithm emphasizes the importance of bipedicled perforator flaps and supercharging/turbocharging when blood flow is required across scars or when a large volume of tissue is needed crossing the midline. In specific cases, where perforator viability is in question because of a previous abdominal surgical procedure, we recommend the inclusion of muscle (Muscle-Sparing-transverse rectus abdominis musculocutaneous vs transverse rectus abdominis musculocutaneous).

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 94%

Algorithmic Approach to the Design and Harvest of Abdominal Flaps for Microvascular Breast Reconstruction in Patients With Abdominal Scars

Nykiel

Hunter

Lee

2015

Annals of Plastic Surgery

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“…Parrett et al 10 also noted significantly higher rates of minor donor-site issues. However, recent studies by Di et al 7 and Hsieh et al 13 have noted no significant differences in donor morbidity, but these studies were significantly limited by the size of the study cohorts. In this current study, minor donor complications trended toward, but were just outside of, being significantly higher in the previous surgery cohort.…”

Section: Discussionmentioning

confidence: 96%

Do Prior Abdominal Surgeries Increase Complications in Abdominally Based Breast Reconstructions?

Wes

Cleveland

Nelson

et al. 2015

Annals of Plastic Surgery

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A significant portion of patients presenting for breast reconstruction have had prior abdominal surgeries. This study demonstrates that these prior procedures represent an acceptable level of risk; although this issue should still be addressed during preoperative patient counseling. In patients with prior hernia repairs, however, additional care should be given to the fascial closure as these patients may be at higher risk for subsequent hernia formation after abdominally based breast reconstruction.

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“…The minimal donor site morbidity in terms of abdominal wall weakness is owing to the fact that the abdominal wall muscle is intact during the SIEA flap procedure. However, there are also major disadvantages of the SIEA flap, including the inconsistent vascular pedicle anatomy and small diameter of the vascular pedicle for the free flap transfer of the whole abdominal tissue [7]. …”

Section: Introductionmentioning

confidence: 99%

The Superficial Inferior Epigastric Artery Flap and its Relevant Vascular Anatomy in Korean Women

et al. 2014

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BackgroundLower abdominal soft tissue transfer is the standard procedure for breast reconstruction. However, abdominal wall weakness and herniation commonly occur postoperatively at the donor site. To reduce the morbidities of the donor site, the superficial inferior epigastric artery (SIEA) flap was introduced, but inconsistent anatomy of the SIEA has reduced its utility. In the present study, the anatomy of the superficial inferior epigastric vessels in Korean women was determined with regards to breast reconstructive surgery.MethodsThe vascular anatomies of the SIEA and superficial inferior epigastric vein (SIEV) were evaluated on 32 breast cancer patients receiving free transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy. The existence, pulsation, location, external diameter, and depth of the SIEA and SIEV were measured at the lower abdominal incision level.ResultsSIEA and SIEV were present in 48/64 (75.00%) and 63/64 (98.44%) hemi-abdomens, respectively. Pulsation of the SIEA was found in 44/48 (91.67%) cases. The mean locations of SIEA and SIEV were +5.79 (±12.87) mm, and -8.14 (±15.24) mm from the midpoint between the anterior superior iliac spine and symphysis pubis, respectively. The mean external diameters of SIEA and SIEV were 1.20 (±0.39) mm and 1.37 (±0.33) mm, and they were found at a mean depth of 9.75 (±2.67) mm and 8.33 (±2.65) mm, respectively.ConclusionsThe SIEA was absent in 25% of Korean women and had a relatively small caliber. Therefore, careful preoperative assessment of the lower abdominal vasculature is required to achieve successful breast reconstruction using SIEA flaps.

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An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars – results from a single surgeon's experience

Cited by 37 publications

References 51 publications

Algorithmic Approach to the Design and Harvest of Abdominal Flaps for Microvascular Breast Reconstruction in Patients With Abdominal Scars

Algorithmic Approach to the Design and Harvest of Abdominal Flaps for Microvascular Breast Reconstruction in Patients With Abdominal Scars

Do Prior Abdominal Surgeries Increase Complications in Abdominally Based Breast Reconstructions?

The Superficial Inferior Epigastric Artery Flap and its Relevant Vascular Anatomy in Korean Women

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