Initial Experience With Laparoscopic Inferior Epigastric Vessel Ligation for Delayed Transverse Rectus Abdominus Musculocutaneous Flap Breast Reconstruction

Trus, Thadeus L.; Collins, E. Dale; Demas, Christopher; Kerrigan, Carolyn L.

doi:10.1001/archsurg.142.4.362

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…This flap is reliant upon the DSEA and accordingly these studies all describe ligation of the inferior abdominal wall vasculature. Both superficial and deep inferior epigastric vessels are specifically noted in all studies excepting Erdmann et al and Trus et al ( 13 , 20 ). The majority of studies also describe bilateral vessel ligation despite only Rickard and Hudson describing bilateral breast reconstruction ( 17 ).…”

Section: Resultsmentioning

confidence: 75%

Surgical delay in abdominal based flap surgery: a scoping review

Rozen,

Yogaraj,

Siddiqui

et al. 2024

Ann Transl Med

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Background The abdominal donor site is the most common flap used for breast reconstruction, with flap necrosis a feared complication. The technique of surgical ‘delay’ involves the inducing of relative ischemia to promote neovascularisation, amongst other metabolic adaptations, and has been used to augment flap vascularity and reduce this complication. There is significant variability in the manner in which flap surgery and surgical delay may be performed, such as the vessels ligated, the presence and degree of flap elevation, and the decision to harvest muscle with the flap, amongst other factors. A formal review of techniques, however, has not yet been performed, and there is no consensus as to the optimal technique for surgical delay. Methods A scoping review of the current literature was undertaken to determine the optimal surgical delay technique in abdominal-based flap surgery. A literature search was conducted across PubMed, Embase, Cochrane, and Medline databases. Data regarding the type of flap surgery, delay techniques, and corresponding clinical outcomes was collected and categorised by technique type. Results Nine studies met the inclusion criteria and were included for review. Levels of evidence and rates of complications were compared. The range of surgical delay techniques reported in the literature was described. Surgical delay was found to reduce overall complication rates, and the available data suggests it may be particularly beneficial in high-risk patients. Conclusions The current data support delay as a viable method for reducing rates of complications. Further studies and data are required to compare surgical delay techniques and determine the benefit delay may pose to patients with risk factors.

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Section: Resultsmentioning

confidence: 75%

Surgical delay in abdominal based flap surgery: a scoping review

Rozen,

Yogaraj,

Siddiqui

et al. 2024

Ann Transl Med

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“…8 Algumas drogas são eficazes em animais, não ocorrendo o mesmo em humanos. Não acreditamos que a embolização 15 e a laqueadura laparoscópica 16 da artéria epigástrica inferior, realizadas por alguns autores, proporcionem os fenômenos da autonomização e sejam eficazes na prevenção das necroses ao confeccionar o retalho. Principalmente porque a incisão de toda a pele e do subcutâneo na autonomização causa maior estímulo isquêmi-co e reações inflamatórias.…”

Section: Discussionunclassified

“…8 Assim, para efetuar uma maior vascularização nesses retalhos, alguns cirurgiões começaram a realizar a "flap delay" (autonomização) 7,9-10 em referência ao chamado "delay phenomenon". [11][12][13] Outros realizaram a embolização 14,15 e alguns, a laqueadura (por meio de laparoscopia) 16 da artéria epigástrica inferior. Como não existe uma explicação razoá-vel de como a autonomização é realizada, este trabalho teve o objetivo de relatar como e quando utilizamos a autonomização do TRAM e seus efeitos.…”

Section: Introductionunclassified

Retalho do músculo reto abdominal transverso autonomizado em pacientes obesas e fumantes

Gonella

Portella

2016

Rev. Fac. Ciênc. Méd. Sorocaba

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RESUMOIntrodução: A reconstrução mamária foi difundida no fim da década de 1970 e no início da de 1980. Nas reconstruções mamárias realizadas por meio do retalho do músculo reto abdominal transverso (TRAM), principalmente em pacientes obesas e fumantes, ocorriam necroses parciais ou totais. Estudos experimentais contribuíram muito para minimizar a necrose, que chegou a cerca de 16%. Porém, nas obesas e fumantes, continuava alarmante o índice de necroses (75%). Alguns autores começaram a realizar embolização ou laqueadura das epigástricas inferiores. Objetivo: O objetivo deste trabalho foi apresentar como fazer a autonomização e seus resultados. Método: Estudo retrospectivo de 13 pacientes, nas quais se utilizou a técnica referida. Foram analisadas por meio dos métodos de Student e Tukey, apresentando sua significância. Resultados: Um paciente apresentou epidermólise. Discussão: Dessa forma, a autonomização propicia uma série de fenômenos que resultam, na maioria das vezes, após período de 10 a 21 dias, no aumento da vascularização local. Conclusão: As táticas cirúrgicas de autonomizar o TRAM e realizar a transposição após 15 dias mostraram-se eficazes. Palavras-chave: mamoplastia; reto do abdome; retalhos cirúrgicos; obesidade; hábito de fumar.ABSTRACT Introduction: Post-Mastectomy Breast reconstruction became popular in the late 1970s and early 1980s. At these surgeries through Transverse Rectus Abdominus Myocutaneous flap (TRAM), mainly in obese and smoking patients, it was demonstrated areas of partial or total necrosis. Experimental studies contributed in many ways to minimize these complications to 16%. But the necrosis occurrence was still high in obese and smoking patients (75%). A few authors began to do embolization or ligature at inferior epigastric plexus. Objective: This study aim is to show a way to make surgical delay of TRAM flap and its results. Methods: Retrospective study from 13 patients, in which this technic was performed. They were analyzed through Student and Tukey methods, presenting its statistical significance Results: One single patient presented epidermolysis. Discussion: The flap delay creates several local exchanges that results, usually after 10 to 21 days, at the increase of local vascular structures. Conclusion: Surgical delay of the TRAM flap as a surgical tactic and its definitive reconstruction after 15 days has been effective. Keywords: mammoplasty; rectus abdominis; surgical flaps; obesity; smoking. INTRODUÇÃOTanzini apresentou a técnica de reconstrução mamária através do músculo grande dorsal em 1896. Bostwick revitalizou essa técnica nos fins da década de 1970. A reconstrução mamária por meio do retalho do músculo reto abdominal transverso (TRAM, em inglês: Trans Rectal Abdominal Muscle) surgiu na década de 1980. Nos eventos das Sociedades de Mastologia e da Cirurgia Plástica, ocorriam inúmeras discussões sobre a vascularização do retalho retoabdominal, realizada pelas artérias epigástricas superiores e inferiores. Como esse retalho é ilhado, abrangendo um leque de pele e...

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“…Inferior epigastric vessels can be accessed through either intra-or extraperitoneal laparoscopic techniques [12][13][14][15]. Laparoscopic ligation of inferior epigastric vessels using intraperitoneal approach was first described in a series of ten patients in 1998 [15] and subsequently a larger case series using the same approach, published with good results [14].…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic ligation of inferior epigastric vessels using intraperitoneal approach was first described in a series of ten patients in 1998 [15] and subsequently a larger case series using the same approach, published with good results [14].…”

Section: Discussionmentioning

confidence: 99%