Autologous Microvascular Breast Reconstruction

Healy, Claragh; Ramakrishnan, Venkat

doi:10.5999/aps.2013.40.1.3

Cited by 18 publications

(19 citation statements)

References 59 publications

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“…The widely accepted first choice for autologous breast reconstruction is the DIEP flap (Granzow et al, 2006; Healy & Ramakrishnan, 2013). The DIEP flap utilizes the laxity of the anterior abdominal wall and provides good volume for unilateral or bilateral cases and a well‐tolerated donor site (Koshima & Soeda, 1989).…”

Section: Discussionmentioning

confidence: 99%

A free intercostal artery perforator flap as a salvage operation for a planned lumbar artery perforator flap with aberrant anatomy in breast reconstruction: A case report

et al. 2021

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When autologous breast reconstruction is planned but abdominal tissue is not available, the lumbar artery perforator flap provides an alternative choice with minimal donor site morbidity. The lumbar and posterior intercostal arteries supply adjacent perforasomes on the posterolateral flank. The purpose of this report is to highlight the salvage of an autologous breast reconstruction free flap using a dorsal perforator of the posterior intercostal artery, when the planned lumbar artery perforators were not suitable. The patient was a 74‐year‐old with recurrent left‐sided breast cancer requiring immediate breast reconstruction. A lumbar perforator flap was planned as an oblique ellipse 19 × 10 cm. Intraoperatively, the two identified perforators traveled superiorly up to the 12th rib and therefore originated from the intercostal rather than lumbar arteries. The internal mammary artery and the vena comitants were used as recipient vessels, anastomosed to an interposition graft. Postoperatively, the patient was discharged home after 7 days without complication. Six months later, the patient was pleased with the reconstruction and had negligible donor site morbidity. The dorsal intercostal artery perforator flap therefore provides a salvage option when presumed lumbar artery perforators are dissected and found to be intercostal in origin.

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Section: Discussionmentioning

confidence: 99%

A free intercostal artery perforator flap as a salvage operation for a planned lumbar artery perforator flap with aberrant anatomy in breast reconstruction: A case report

et al. 2021

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“…Insufficient donor tissue is particularly relevant, as the variability in retention often results in return trips to the operating room to harvest additional fat for grafting. Donor site morbidities may cause significant further harm to the patient 21 and complications include infection, necrosis, thrombosis, hematoma, and flap loss 22,23 .…”

Section: Discussionmentioning

confidence: 99%

An immunologically active, adipose-derived extracellular matrix biomaterial for soft tissue reconstruction: concept to clinical trial

Anderson¹,

Wu²,

Parrillo³

et al. 2020

Preprint

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Soft tissue reconstruction remains an intractable clinical challenge as current surgical options and synthetic implants may produce inadequate outcomes. Soft tissue deficits may be surgically reconstructed using autologous adipose tissue, but these procedures can lead to donor site morbidity, require multiple trips to the operating room, and have highly variable outcomes. To address the clinical need for soft tissue reconstruction, we developed an off-the-shelf adipose matrix from allograft human adipose tissue (acellular adipose tissue, AAT). We applied physical and chemical processing methods to remove lipids and create an injectable matrix that mimicked the properties of fat grafting materials. Biological activity was assessed using cell migration and stem cell adipogenesis assays. Characterization of the regenerative immunology properties in a murine muscle injury model revealed allograft and xenograft AAT induced pro-regenerative CD4+ T cells and macrophages with xenograft AAT attracting additional eosinophils secreting interleukin 4 (Il4). In immunocompromised mice, AAT injections retained similar tissue volumes as human fat grafts but did not have the cysts and calcifications that formed in the human fat graft implants. Combination of AAT with human adipose-derived stem cells (ASCs) resulted in lower implant volumes. However, tissue remodeling and new adipose development increased significantly with the addition of cells. Larger injected volumes of porcine-derived AAT demonstrated biocompatibility and greater volume retention when applied allogeneicly in Yorkshire cross pigs. Under a biologic IND application, AAT was implanted in healthy volunteers in abdominal tissue that was later removed (panniculectomy or abdominoplasty). The AAT implants were well tolerated and biocompatible in all eight human subjects. Analysis of implants removed between 1 and 18 weeks demonstrated increasing cellular infiltration and immune populations, suggesting continued tissue remodeling and the potential for long term tissue replacement.

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“…The physical properties of the SIEA free flap are similar to those of the SCIP free flap, and when the skin flap is harvested, the muscle layer at the donor site is not damaged [ 3 ]. Therefore, SIEA flaps have excellent results in terms of healing at the donor site [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Foot Using a Superficial Inferior Epigastric Artery Free Flap

2017

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When foot reconstruction is performed in the pretibial area, the ankle, or the dorsum of the foot, the need for a reliable flap remains a challenge. We found that the superficial inferior epigastric artery (SIEA) free flap can be used as an alternative tool for this purpose, as it helps to solve the problems associated with other flaps. We describe 2 cases in which we reconstructed the foot using an SIEA free flap, which was pliable enough to fit the contours of the area. Postoperatively, the flaps were intact and showed excellent aesthetic results. Thus, the SIEA free flap can be an alternative tool for patients with a low body mass index who undergo reconstructive surgery involving the pretibial area, ankle, knee, or dorsum of the foot, all of which require a soft and flexible flap.

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Autologous Microvascular Breast Reconstruction

Cited by 18 publications

References 59 publications

A free intercostal artery perforator flap as a salvage operation for a planned lumbar artery perforator flap with aberrant anatomy in breast reconstruction: A case report

A free intercostal artery perforator flap as a salvage operation for a planned lumbar artery perforator flap with aberrant anatomy in breast reconstruction: A case report

An immunologically active, adipose-derived extracellular matrix biomaterial for soft tissue reconstruction: concept to clinical trial

Reconstruction of the Foot Using a Superficial Inferior Epigastric Artery Free Flap

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