Bilateral Outpatient Breast Reconstruction with Stacked DIEP and Vertical PAP Flaps

Martínez, Carlos A.; Fairchild, Berry; Rio, Roberto Secchi Del; Boutros, Sean

doi:10.1097/gox.0000000000003878

Cited by 12 publications

(8 citation statements)

References 42 publications

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“…Originally the PAP flap was described as a pedicled option for ischiatic pressure sores (Arquette et al, 2022 ; Homma et al, 2001 ; Kim et al, 2014 ; Lee et al, 2009 ; Sharp et al, 2021 ) and as a free flap for head and neck reconstruction, including tongue (Heredero et al, 2021 ; Riera et al, 2017 ; Scaglioni et al, 2015 ). A recent expanding use is for breast reconstruction (Ahmadzadeh et al, 2007 ; Allen et al, 2012 , 2016 ; Angrigiani et al, 2001 ; Atzeni et al, 2021 ; Cho et al, 2021 ; Jo et al, 2022 ; Martinez et al, 2021 ; Murphy et al, 2021 ; Saad et al, 2012 ; Song et al, 2020 ; Yano et al, 2020 ). Murphy et al ( 2021 ) demonstrated the superiority of the PAP flap compared to the IGAP flap as alternative option to the DIEP flap in breast reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The profunda femoris artery perforator (PAP) flap has been recently popularized as an alternative option for microsurgical reconstruction Filippo Boriani and Paolo Sassu equally contributed to the idea, the development and the editing of the study. (Atzeni et al, 2021;Cho et al, 2021;Ciudad et al, 2022;Heredero et al, 2021;Jo et al, 2022;Karakawa, Yoshimatsu, Fuse, et al, 2020;Kehrer et al, 2018;Martinez et al, 2021;Murphy et al, 2021). Historically, based on proximal musculocutaneous perforators from the adductor magnus (AM) muscle, it was initially referred as "adductor flap" by Angrigiani et al (2001).…”

Section: Introductionmentioning

confidence: 99%

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The profunda artery perforator flap for upper limb reconstruction: A case report and literature review on the flap applications in reconstruction

et al. 2022

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The profunda femoris artery perforator (PAP) flap has been recently popularized as an alternative option for microsurgical reconstruction. The use of PAP flap has never been reported and described for reconstruction of the upper extremities, in particular the forearm. The purpose of this case report is to describe a case suggesting the PAP flap as a further reconstructive option in the upper limb. A 16‐year‐old girl who sustained a traumatic injury to her right dominant forearm resulting in subtotal circumferential tissue loss following a road traffic accident was referred to the authors' department 2 years post‐trauma. The disabling fibrotic sequelae on her volar forearm (15 × 10 cm) resulted in a nonfunctional hand. She was unable to perform any active movement of her wrist or digits. Passive movements in the finger joints were preserved. Following debridement and reconstruction of nerves and tendons, soft tissues were resurfaced with a PAP flap. The transverse skin paddle, 12 × 7 cm, was placed distally with the adipofascial portion positioned proximally above the muscle bellies and anastomoses site. A small raw area (4 × 3 cm) was covered with an acellular dermal matrix (ADM). The postoperative course was uneventful. At 9 months postoperatively, the patient demonstrated active flexion and extension of the fingers with independent function. The patient reported satisfaction with the flap donor site and forearm resurfacing. The PAP flap can be a further option for areas requiring soft tissue coverage in patients refusing visible scars. This flap had both the advantage of reducing the morbidity and visibility of the donor site, as well as the ability to resurface a large recipient site with soft and pliable tissue, covering exposed nerves and tendons.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The profunda artery perforator flap for upper limb reconstruction: A case report and literature review on the flap applications in reconstruction

et al. 2022

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“…2); a video detailing this technique has been published by the authors. 7 The pedicle is taken to the confluence of the external iliac, with a typical pedicle length of 12 to 15 cm depending on perforator location.…”

Section: Methodsmentioning

confidence: 99%

Abdominoplasty and Breast Augmentation with Outpatient Cosmetic Deep Inferior Epigastric Perforator Flaps

Martínez

Boutros

2022

Plastic &Amp; Reconstructive Surgery

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Breast augmentation became the most common cosmetic surgical procedure in 2019, with more than 280,000 operations performed in the United States. 1 Breast augmentation with implants is a relatively inexpensive and straightforward low-risk procedure that yields good results. Early potential problems are well-known; later complications, such as rupture, long-term deflation, malposition, pain, and capsular contraction, typically require surgical correction. Significant long-term complications, such as breast implant-associated anaplastic large cell lymphoma 2 and breast implant illness, 3 occur in Background: The authors describe the use of deep inferior epigastric perforator (DIEP) flaps in outpatient cosmetic breast augmentation. Methods: The authors reviewed patients who had undergone cosmetic breast augmentation with DIEP flaps over a 12-month period. Any patient who desired breast augmentation, implant exchange, or augmentation mastopexy with concomitant abdominoplasty was considered a candidate for the procedure. All patients underwent an early recovery protocol including microfascial incisions to harvest the DIEP flaps and rib preservation in addition to early recovery after surgery protocols with intraoperative anesthetic blocks. Results: Eleven consecutive patients underwent bilateral cosmetic breast augmentation with DIEP flaps and mastopexy. Overall, all patients reported preoperative dissatisfaction with their abdomen and breasts. Microfascial incisions for single perforator abdominal flaps (n = 17) averaged 1.7 cm (range, 1.3 to 2.4 cm) and flaps with multiple perforators (n = 5) averaged 2.4 cm (range, 2 to 2.5 cm). Dissection of recipient internal mammary artery vessels was performed without disruption of the rib. No fascia or muscle tissue was taken during flap dissection. All patients had strong Doppler signals before discharge within 23 hours. No partial or total flap losses, major complications, or take-backs were reported. Conclusions: Patients who desire abdominoplasty and augmentation are ideal candidates for this procedure. Breast augmentation with autologous tissue, particularly the DIEP flap, is an attractive option inherent to the additional abdominal tissue available to harvest. The early recovery protocol allows the surgeon to perform microsurgical breast reconstructions and augmentations in an outpatient setting, with excellent results and no total or partial flap losses, offsetting the high costs associated with the DIEP flap.

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“…The two flaps can then be inset side-by-side in a fashion referred to as "stacked" (Patel et al, 2016). In this case, the vascular supply is usually provided by antegrade and retrograde anastomoses with the internal mammary vessels (Martinez et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Stacked profunda artery perforator flaps with intra‐flap anastomosis for moderate to large breast autologous reconstruction

2022

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Background The profunda artery perforator (PAP) flap is a reliable alternative for autologous breast reconstruction; however, the amount of tissue provided is quite limited. For medium to large sized breast reconstruction two PAP flaps can be harvested and inset in “stacked” fashion. This procedure consists in placing the two flaps side by side, normally supplied by antegrade and retrograde anastomoses performed with the mammary vessels. In the present article, we report the employment of stacked PAP flaps with intra‐flap anastomosis in breast reconstruction setting. Patients and methods From April 2018 to December 2021, seven patients received unilateral breast reconstruction with stacked PAP flaps. Patients' average age was 47.5 (range 39–58 years old). Mean body mass index was 19.4 kg/m2 (range 18.5–20.1 kg/m2). The two flaps were linked by means of intra‐flap anastomosis resorting to side branches of one of the two pedicles. In all cases the internal mammary vessels were dissected sparing the ribs and used as recipient vessels for antegrade end‐to‐end anastomosis. Results The flaps size ranged from 15 cm × 6 cm to 20 cm × 7 cm with an average weight of 250 g (range 190–290 g). The mean pedicle length was 11.1 cm (range 10–12.5 cm) on the left side and 7.9 cm (range 7–9 cm) on the right side. All flaps survived completely after surgery. The donor sites were all primarily closed with no morbidities. The mean follow‐up was 8 months (range 6–12 months). All patients were satisfied with the result. Conclusions Stacked PAP flaps performed with intra‐flap anastomosis may represent a valid alternative solution for the reconstruction of moderate to large breast in case of unavailable abdominal tissue.

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Bilateral Outpatient Breast Reconstruction with Stacked DIEP and Vertical PAP Flaps

Cited by 12 publications

References 42 publications

The profunda artery perforator flap for upper limb reconstruction: A case report and literature review on the flap applications in reconstruction

The profunda artery perforator flap for upper limb reconstruction: A case report and literature review on the flap applications in reconstruction

Abdominoplasty and Breast Augmentation with Outpatient Cosmetic Deep Inferior Epigastric Perforator Flaps

Stacked profunda artery perforator flaps with intra‐flap anastomosis for moderate to large breast autologous reconstruction

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