Thoracoacromial artery and vein as main recipient vessels in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction

Yamamoto, Takumi; Kageyama, Takashi; Sakai, Hayahito; Fuse, Yuma; Tsukuura, Reiko; Yamamoto, Naoki

doi:10.1002/jso.26421

Cited by 9 publications

(4 citation statements)

References 27 publications

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“…1). 15–91 A list of all included studies is available in Supplemental Digital Content 3. ( See table, Supplementary Digital Content 3 , which displays characteristics and references of all included studies.…”

Section: Resultsmentioning

confidence: 99%

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Kim

Yuan

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Breast reconstruction after mastectomy in breast cancer patients is known to provide significant improvements in psychological well-being. 1 Among various techniques available, the deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard for autologous breast reconstruction. 2 Despite the clinical importance and high regard of the DIEP flap technique, most research studies in leading plastic surgery journals are nonrandomized and observational in nature. 3 Nonrandomized observational studies on DIEP flap breast reconstruction have shown high risk of bias in their methodology. 2 Nonrandomized observational studies are generally considered to be of lesser quality evidence compared with randomized controlled trials (RCT) and systematic reviews/meta-analyses of RCTs. Nonetheless, observational studies are commonplace in plastic surgery. The prevalence of observational research, in part, is due to being less resource intensive and easier to conduct. 4 Other Breast Original articleBackground: The deep inferior epigastric artery perforator (DIEP) flap is widely used in autologous breast reconstruction. However, the technique relies heavily on nonrandomized observational research, which has been found to have high risk of bias. "Spin" can be used to inappropriately present study findings to exaggerate benefits or minimize harms. The primary objective was to assess the prevalence of spin in nonrandomized observational studies on DIEP reconstruction. The secondary objectives were to determine the prevalence of each spin category and strategy. Methods: MEDLINE and Embase databases were searched from January 1, 2015, to November 15, 2022. Spin was assessed in abstracts and full-texts of included studies according to criteria proposed by Lazarus et al. Results: There were 77 studies included for review. The overall prevalence of spin was 87.0%. Studies used a median of two spin strategies (interquartile range: 1-3). The most common strategies identified were causal language or claims (n = 41/77, 53.2%), inadequate extrapolation to larger population, intervention, or outcome (n = 27/77, 35.1%), inadequate implication for clinical practice (n = 25/77, 32.5%), use of linguistic spin (n = 22/77, 28.6%), and no consideration of the limitations (n = 21/77, 27.3%). There were no significant associations between selected study characteristics and the presence of spin. Conclusions:The prevalence of spin is high in nonrandomized observational studies on DIEP reconstruction. Causal language or claims are the most common strategy. Investigators, reviewers, and readers should familiarize themselves with spin strategies to avoid misinterpretation of research in DIEP reconstruction.

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Section: Resultsmentioning

confidence: 99%

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Kim

Yuan

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Traditionally, the IMA has been the preferred choice (Chow et al, 2017), but when compromised, the TAV emerges as a viable alternative. While literature has demonstrated the reliability of TAV, particularly in the context of breast reconstruction (Kim et al, 2019; Kompatscher et al, 2005; Singh et al, 2017; Yamamoto et al, 2021), its application to the chest wall and sternal wounds has been predominantly limited to case reports, and comprehensive studies are lacking. To address this research gap, our report aimed to provide a thorough review of cases of free tissue transfer using TAV as recipients for complicated chest wall defects at the tertiary referral center.…”

Section: Discussionmentioning

confidence: 99%

“…However, the lack of a definitive approach highlights the need for comprehensive research to identify the optimal alternatives for anterior chest wall reconstruction. In recent years, the thoracoacromial vessel (TAV) has gained attention as a potential recipient vessel for breast reconstruction (Singh et al, 2017; Yamamoto et al, 2021). Nevertheless, its application in chest wall reconstruction remains primarily documented in case reports, with limited evidence regarding its effectiveness in diverse clinical settings.…”

Section: Introductionmentioning

confidence: 99%

Microsurgical reconstruction using thoracoacromial vessels as recipients for complicated chest wall defects

Kim,

Lee

2024

Microsurgery

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BackgroundFree tissue transfer is often required for the reconstruction of complex and deep anterior chest wall wounds, for which the identification of suitable recipient vessels is crucial. Although the internal mammary arteries (IMAs) are a representative option, identifying secondary options when these vessels are compromised remains a challenge. This report evaluated the efficacy of using the thoracoacromial vessels (TAVs) as recipients for chest wall reconstruction by reviewing our experience.MethodsWe conducted a retrospective review of patients undergoing free‐flap‐based chest wall reconstruction using TAVs as recipient vessels from February 2020 to March 2023. Patient demographics and surgery‐related characteristics data were collected. The primary outcome of interest was the occurrence of flap perfusion‐related complications.ResultsIn total, 12 cases utilized TAVs as recipients, primarily for defects following sternotomy, where bilateral IMA was unavailable due to prior surgery. The TAVs with reliable perfusion were consistently identified beneath the pectoralis major muscle. The anterolateral thigh flap was predominantly employed, with musculocutaneous or chimeric flaps introduced for bony defects. The mean pedicle length of the harvested flap was 7.2 cm (range, 3–13), and in cases with a vascular gap, the pedicle was extended using an arteriovenous interposition graft. This resulted in a mean pedicle length needed to reach recipient vessels of 9.9 cm (range, 6.5–19). All flaps survived, with only one experiencing partial necrosis.ConclusionsThe TAV could be considered as an attractive alternative recipient vessel in microsurgical reconstruction of complicated chest wall defects when the use of IMA is not feasible.

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“…Additionally, a free TAT true-perforator flap can be a new option for the reconstruction of the face with many advantages including reduced donor-site morbidity and satisfactory aesthetic outcome [ 5 ]. The TAT can be also safely used as recipient vessel for deep inferior epigastric artery perforator flap breast reconstruction with shorter time and less postoperative pain [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

The thoracoacromial trunk: a detailed analysis

Bonczar

Gabryszuk²,

Ostrowski

et al. 2022

Surg Radiol Anat

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Purpose The thoracoacromial trunk (TAT) originates from the second part of the axillary artery and curls around the superomedial border of the pectoralis minor, subsequently piercing the costocoracoid membrane. Knowledge about the location, morphology, and variations of the TAT and its branches is of great surgical importance due to its frequent use in various reconstructive flaps. Methods A retrospective study was conducted to establish anatomical variations, their prevalence, and morphometric data on TAT and its branches. The results of 55 consecutive patients who underwent neck and thoracic computed tomography angiography were analyzed. A qualitative evaluation of each TAT was performed. Results A total of 15 morphologically different TAT variants were initially established. The median length of the TAT was set at 7.74 mm (LQ 3.50; HQ 13.65). The median maximum diameter of the TAT was established at 4.19 mm (LQ 3.86; HQ 4.90). The median TAT ostial area was set to 13.97 mm (LQ 11.70; HQ 18.86). To create a heat map of the most frequent location of the TAT, measurements of the relating structures were made. Conclusion In this study, the morphology and variations of the branching pattern of the TAT were presented, proposing a new classification system based on the four most commonly prevalent types. The prevalence of each branch arising directly from the TAT was also analyzed. It is hoped that the results of the present anatomical analysis can help to minimize potential complications when performing plastic or reconstructive procedures associated with TAT.

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Thoracoacromial artery and vein as main recipient vessels in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction

Cited by 9 publications

References 27 publications

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

“Spin” in Observational Studies in Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A Systematic Review

Microsurgical reconstruction using thoracoacromial vessels as recipients for complicated chest wall defects

The thoracoacromial trunk: a detailed analysis

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