Optimization of breast reconstruction results using TMG flap in 30 cases: Evaluation of several refinements addressing flap design, shaping techniques, and reduction of donor site morbidity

Nickl, Stefanie; Nedomansky, Jakob; Radtke, Christine; Haslik, Werner; Schroegendorfer, K.

doi:10.1002/micr.30290

Cited by 15 publications

(23 citation statements)

References 22 publications

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“…Studies not relevant (74 articles), cadaver or imaging studies (4 articles), case reports (3 articles), reviews (5 articles), and reports in languages other than English (5 articles) were further excluded, resulting in 21 articles for full‐text review. After excluding three articles lacking extractable data or with suspected cohort overlap, we identified 16 articles for systematic analysis (Figure 1a) (Arnez et al, 2004; Bodin et al, 2015; Bodin et al, 2016; Buntic, Horton, Brooks, & Althubaiti, 2011; Craggs et al, 2014; Fansa, Schirmer, Warnecke, Cervelli, & Frerichs, 2008; Fattah, Figus, Mathur, & Ramakrishnan, 2010; Hunter, Lardi, Dower, & Farhadi, 2015; Kind & Foster, 2008; Locke, Zhong, Mureau, & Hofer, 2012; Nickl, Nedomansky, Radtke, Haslik, & Schroegendorfer, 2018; Park, Alkureishi, & Song, 2015; Saint‐Cyr et al, 2012; Schoeller et al, 2008; Wechselberger et al, 2016; Wechselberger & Schoeller, 2004; Werdin, Haug, Amr, & Schoeller, 2016). The initial PAP flap search yielded 252 articles.…”

Section: Resultsmentioning

confidence: 99%

Comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: A systematic review

Kim

Eom

et al. 2020

Microsurgery

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Background Thigh‐based flaps are generally considered a secondary option for breast reconstruction, with inner thigh‐based transverse upper gracilis (TUG) flaps being the preferred choice for many surgeons; however, its well‐established drawbacks include short pedicle length, lack of volume, and donor morbidity. The posterior thigh‐based profunda femoris artery perforator (PAP) flap was introduced as an alternative approach, but these flaps were not comparatively analyzed with TUG flaps on a large scale. We aimed to systematically review TUG‐ and PAP‐flap breast reconstruction to determine the better secondary option. Methods We performed a systematic review of the literature using the PubMed database. Our selected series for systematic analyses included 613 TUG flaps in 432 patients and 475 PAP flaps in 329 patients. Elementary data on the flaps and complications were collected and analyzed. Pooled estimates of proportions of flaps with recipient complications and donor site morbidity were compared using random effect single arm meta‐analysis. Results The basic patient demographics were comparable between the flap types. The mean operation time was comparable. The PAP flap had longer pedicle length and higher flap weight. The total loss (p = .6579), partial loss rate (p = .3247), and fat necrosis rate (p = .0771) were comparable between flap types. Regarding donor morbidity, the PAP flap group had less wound dehiscence (p < .0001) and lower rate of sensory disturbance (p < .0001). Conclusions The study findings indicate that the PAP flap, when compared with the TUG flap, could be a better secondary option for breast reconstructions.

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Section: Resultsmentioning

confidence: 99%

Comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: A systematic review

Kim

Eom

et al. 2020

Microsurgery

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“…However, due to inadequate tissue availability, previous surgeries or patient's preference, surgeons might choose alternative donor sites. The medial thigh is a valuable option for soft tissue harvest [5][6][7][8][9]. First introduced in 1992 by Yousif et al, the transverse musculocutaneous gracilis (TMG) flap exploits the excess of fat and skin laxity of the medial thigh to reconstitute breast volume [10,11].…”

Section: Introductionmentioning

confidence: 99%

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

et al. 2021

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Purpose The transverse musculocutaneous gracilis (TMG) flap is as a valuable alternative in autologous breast reconstruction. The purpose of this study was to evaluate the donor site morbidity and secondary refinement procedures after TMG flap breast reconstruction. Methods A retrospective study was conducted, including all patients who received TMG flap breast reconstructions, from January 2012 to August 2019. Primary outcomes were surgical site complications of the donor site and secondary refinement procedures carried out for aesthetic or reconstructive purposes for the medial thigh. Secondary outcomes of interest were lipofilling procedures for optimization of the reconstructed breasts. Results Ninety-nine patients received 159 TMG flaps for breast reconstruction. Patients’ mean BMI was 23.5 (15.6–32.5) kg/m2. Bilateral breast reconstructions were performed in 60.6%. The mean flap volume was 330 (231–440) g. Surgical site complications occurred in 14.5% of the TMG donor sites and wound dehiscence was the most common complication (9.4%). Lymphedema occurred in 1.8% of the donor thighs. Aesthetic refinement procedures were performed in 25.2% on the donor thigh or contralateral thigh. Secondary lipofilling was performed in 54.1% of the reconstructed breasts and fat was harvested in only 11.9% from the legs. Conclusion The TMG flap breast reconstruction combines low donor site morbidity with adequate volume for appealing breast results, particularly in slim-to-normal weight patients. However, patients should be informed about the likelihood of secondary refinement procedures on the donor site and the need of lipofilling to optimize the breast shape and volume.

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“…We read with great interest the article entitled "Optimization of breast reconstruction results using TMG flap in 30 cases: Evaluation of several refinements addressing flap design, shaping techniques, and reduction of donor site morbidity." by Nickl, Nedomansky, Radtke, Haslik, and Schroegendorfer (2018). Even though there were no complications of lymphedema in their study, there have been some reports on lymphedema following transverse myocutaneous gracilis (TMG) flap elevation (Puelzl, Schoeller, Kleewein, & Wechselberger, 2011).…”

Section: Sirsmentioning

confidence: 87%

Indocyanine green lymphography for diagnosis of lymphedema following thigh lift surgery

2018

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Optimization of breast reconstruction results using TMG flap in 30 cases: Evaluation of several refinements addressing flap design, shaping techniques, and reduction of donor site morbidity

Cited by 15 publications

References 22 publications

Comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: A systematic review

Comparison of transverse upper gracilis and profunda femoris artery perforator flaps for breast reconstruction: A systematic review

The transverse musculocutaneous gracilis flap for autologous breast reconstruction: focus on donor site morbidity

Indocyanine green lymphography for diagnosis of lymphedema following thigh lift surgery

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