TUGs into VUGs and Friendly BUGs

Park, Julie E.; Alkureishi, Lee W. T.; Song, David H.

doi:10.1097/prs.0000000000001557

Cited by 53 publications

(14 citation statements)

References 14 publications

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“…In our review, when two TUG flaps were inserted to make one breast, the thoracodorsal arteries were predominantly the recipient of choice for the second flap (Schoeller et al, 2008;Werdin et al, 2016). This cumbersome process may be the result of the short pedicle length to reach the retrograde internal mammary vessels upon flap stacking, although Park et al reported some exceptions (Park et al, 2015). In contrast, most of the stacked PAP flap cases utilized retrograde internal mammary vessels without any special notes.…”

Section: Discussionmentioning

confidence: 88%

“…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, ;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.…”

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confidence: 99%

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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: Discussionmentioning

confidence: 88%

mentioning

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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“…In order to address some of these issues, the TUG flap skin paddle design has been modified by some authors, by changing its orientation. These variations, the diagonal/ oblique upper gracilis (DUG) [8] and vertical upper gracilis (VUG) flaps [9], avoid placing a scar on the posterior thigh and ease the closure of the donor site, but do not offer a substantial increase in the overall flap volume which can be harvested.…”

Section: Introductionmentioning

confidence: 99%

The L-shaped modification of the transverse upper gracilis (TUG) flap

2020

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A variety of free tissue flaps have been described for autologous breast reconstruction. Although the deep inferior epigastric perforator (DIEP) flap is most microsurgeons' first choice, there is no consensus regarding which is the second-best alternative. The transverse upper gracilis (TUG) flap has gained popularity for cases where the abdomen is not a suitable donor site. This musculocutaneous flap has the advantage of an easy dissection, allowing the harvest of tissue from the medial thigh area with the patient supine. However, drawbacks include a tedious donor site closure and a limited amount of soft tissue that can be transferred. The authors hereby present a modification of the TUG flap, introducing an L-shaped skin paddle: the L-shaped upper gracilis (LUG) flap. This alternative allows harvesting extra tissue from the medial thigh, while providing an easier donor site closure with the patient supine. A prospective case series of 14 LUG flaps is presented. No flap failures or episodes of fat necrosis were encountered; only one developed a donor site seroma that settled after drainage. The LUG flap is a useful development of the TUG flap concept providing up to 50% more tissue than a standard TUG flap with an aesthetically pleasing donor site closure which is useful for cases in which abdominal flaps are not possible. Level of evidence: Level IV, therapeutic study.

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“…The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2%, p = 0.0047, RR 1.71) which was expected due to decreased flap size compared to the double DIEP flap, and therefore, more occasionally, volume insufficiencies. In a recently published study by Park et al, fat grafting was needed in 13 of 22 (59%) TMG patients after unilateral breast reconstruction [ 27 ]. Since a majority of patients will undergo postoperative symmetrization procedures or a nipple areola complex reconstruction, the need for postoperative lipofilling represents no limitation to use double TMG flaps for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis

Weitgasser

Schwaiger

Medved

et al. 2020

JCM

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Background: A two center retrospective cohort study of simultaneous bilateral breast reconstructions using double deep inferior epigastric perforator (DIEP) flaps and double transverse myocutaneous/upper gracilis (TMG) flaps was conducted. The aim of this study was to compare surgical procedures, complications, and overall outcome. Patients and Methods: Two study groups, either receiving a simultaneous bilateral breast reconstruction, with double DIEP flaps (n = 152) in group 1, or double TMG flaps (n = 86) in group 2, were compared. A detailed risk and complication analysis was performed. Patient characteristics, operative time and the need for further operations were evaluated. Results: Double DIEP patients had donor site complications in 23.7% and double TMG patients in 16.3% (p = 0.9075, RR 1.45). Flap loss rates of 3.5% (double TMG) and 2.6% (double DIEP) were recorded (p = 0.7071, RR 1.33). The need for postoperative lipofilling was significantly higher in double TMG patients (65.1% vs. 38.2 %, p = 0.0047, RR 1.71). Conclusion: Complication analysis favors the double DIEP procedure. Donor site morbidity was lower and less severe in the double TMG group. Later fat grafting was more frequently needed after double TMG reconstructions. Further studies, preferably of prospective nature, are needed to evaluate the benefit of bilateral simultaneous breast reconstructions.

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TUGs into VUGs and Friendly BUGs

Abstract: Therapeutic, IV.

Cited by 53 publications

References 14 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 L-shaped modification of the transverse upper gracilis (TUG) flap

Bilateral Simultaneous Breast Reconstruction with DIEP- and TMG Flaps: Head to Head Comparison, Risk and Complication Analysis

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