Supercharging of delayed pedicled transverse rectus abdominis myocutaneous flaps, is it a viable option?

Vosburg, R. Wesley; White, Michael; Heckler, Frederick R.

doi:10.1002/micr.22301

Cited by 8 publications

(16 citation statements)

References 19 publications

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“…Thus, even if microscopic anastomosis failure occurred, secondary rescue would be possible due to the crossed blood flow between the perforasomes from a reliably pedicled TRAM flap. Some studies have also described supercharged anastomosis of an ipsilateral DIEP flap combined with a pedicled TRAM flap to avoid delayed arterial and venous insufficiency [10,11]. Although this technique is somewhat similar to that presented herein in that both involve conjoined flaps made by combining a pedicled TRAM flap with a microvascular anastomosed flap, the crucial difference is whether or not the source vessels come from both sides beyond the midline of the abdominal flap.…”

Section: Discussionmentioning

confidence: 82%

“…Modified microvascular techniques including the use of two pedicles, or the supercharged pedicle flap, and the turbocharged flap have been introduced to enhance the vascular supply to flaps and to decrease the risk of vascular complications [8][9][10][11]. A turbocharged abdominal flap is a type of conjoined flap formed by combining the single pedicle with a retrograde loop anastomosis of the contralateral DIEP [8].…”

Section: Discussionmentioning

confidence: 99%

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Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy

Kim

et al. 2021

Arch Aesthetic Plast Surg

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Delayed breast reconstruction is challenging because it requires a large volume and symmetry, and the dual-pedicled deep inferior epigastric perforator (DIEP) flap is used with microvascular augmentation. However, candidate recipient vessels in patients who have undergone radiation therapy may be damaged, with uncertain patency. This report suggests a novel method, the dual-pedicled conjoined abdominal flap, in which a free DIEP flap is combined with a pedicled transverse rectus abdominis muscle (TRAM) flap. A 57-year-old female patient who had undergone modified radical mastectomy and radiotherapy 25 years previously was referred for breast reconstruction. A whole abdominal flap was needed, but supercharged anastomosis was very risky due to calcification and scarring of the internal mammary vessel. Therefore, the thoracodorsal vessels were anastomosed with a free left DIEP flap, which was combined with a right-pedicled TRAM flap. The reconstructed volume was sufficient, and the blood flow was intact. The patient presented a symmetric contour without any complications after 4 months. The dual-pedicled conjoined abdominal flap is reliable for delayed breast reconstruction that requires a large volume and skin replacement, especially in patients with radiation-injured recipient vessels. Even if microscopic anastomosis failure occurs, secondary rescue is made possible by the pedicled TRAM flap.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy

Kim

et al. 2021

Arch Aesthetic Plast Surg

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“…27,28 Another view is that an additional artery in the distal part of the flap could increase arterial blood supply, thus improving flap complications. 29–32 However, arterial supercharging also affects the vein, increasing the burden of venous drainage, which could lead to flap necrosis if used improperly. 33 The best flap survival occurs with both arterial supercharging and venous superdrainage.…”

Section: Discussionmentioning

confidence: 99%

A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap

Cheng

Lou

et al. 2019

Plastic &Amp; Reconstructive Surgery

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Background:Conjoined flap viability is associated with arterial blood supply and venous return. This study aimed to assess the effects of venous drainage position on arterial blood supply and venous return within the conjoined flap.Methods:Fifty-four rats were divided randomly into three groups (n = 18 per group). In experimental group 2, only the right intercostal posterior artery and the left iliolumbar vein were maintained; meanwhile, only the right intercostal posterior artery and the left intercostal posterior vein were preserved in experimental group 1. The control group had only the right intercostal posterior artery and vein preserved. The distances between angiosomes were measured. At 7 days after surgery, flap survival was evaluated, lead oxide–gelatin flap angiography was performed, and average microvessel density was assessed by hematoxylin and eosin staining, and lactate levels were assessed.Results:The distance between angiosomes I and II was the shortest, whereas angiosomes I and III were most distant (p < 0.05). At 7 days after surgery, survival rates in experimental group 2 and experimental group 1 were both 100 percent, whereas 86.5 ± 1.6 percent of controls survived. Furthermore, angiogenesis was more obvious in experimental group 2 than in experimental group 1 and controls. Moreover, lactate levels were lower in experimental group 2 (7.47 ± 0.17 mM) and experimental group 1 (8.03 ± 0.31 mM) compared with control values (9.98 ± 0.37 mM; p < 0.05).Conclusion:Changes in position of venous drainage might cause continuous arterial high-pressure perfusion and venous superdrainage, which improves flap survival.

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“…Supercharging is an established technique to enhance perfusion of pedicled or free flaps (7). Basically, supercharging means that an additional vessel is connected to supply the transferred tissue with blood.…”

Section: Discussionmentioning

confidence: 99%

Vascularised and Modified Lower-Leg Rotationplasty for the Treatment of Severe Infection and Bone Loss of the Proximal Femur: A Case Report

et al. 2017

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Supercharging of delayed pedicled transverse rectus abdominis myocutaneous flaps, is it a viable option?

Abstract: Our findings demonstrate patency of the inferior epigastric vessels after ligation for TRAM delay during the time frame usually used for delay to take effect.

Cited by 8 publications

References 19 publications

Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy

Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy

A Preliminary Study of the Effects of Venous Drainage Position on Arterial Blood Supply and Venous Return within the Conjoined Flap

Vascularised and Modified Lower-Leg Rotationplasty for the Treatment of Severe Infection and Bone Loss of the Proximal Femur: A Case Report

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