Vascular pedicle avulsion in free flap breast reconstruction: A case of diep flap salvage following early avulsion of venous anastomosis and literature review

Lykoudis, Efstathios G.; Ziogas, Dimosthenis; Papanikolaou, G.

doi:10.1002/micr.20738

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…Although vascular pedicle avulsion in breast reconstruction is an extremely rare complication, pedicle damage in free flap surgery is well documented, 11 while TD pedicle injury during axillary lymph nodes dissection is still poorly debated in literature.…”

Section: Discussionmentioning

confidence: 99%

Accidental injury of the latissimus dorsi flap pedicle during axillae dissection: Types and reconstruction algorithm

et al. 2013

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The intra-operative latissimus dorsi (LD) pedicle damage during axillary lymph-node dissection by the general surgeon is a rare complication leading to flap failure and poor outcomes. The authors present their experience on this topic and develop a classification of the thoracodorsal (TD) pedicle injuries and reconstruction algorithm. Pedicle damage of LD occurred in five cases, three of which were experienced during immediate breast reconstruction and two observed in patients who underwent prior surgery. In two cases the thoracodorsal vein (TDV) was damaged in its proximal segment, thus end-to-end anastomosis was performed between distal stump of TDV and circumflex scapular vein (CSV). In one case the TDV required simple microsurgical repair while in other two cases the severe damage of vein and artery required more complex surgical strategies in attempt to salvage the flap. Four cases completely survived with one case of rippling phenomenon. One case had partial flap necrosis that required subtotal muscle resection. Based on these cases, the authors have developed a reconstruction algorithm in attempt to repair LD pedicle damage while preserving breast reconstruction. Taking into account its anatomical conformation, TD pedicle injuries are classified in four different types and available options are suggested for all of them according to the anatomical site and to the mechanism and timing of injury.

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Section: Discussionmentioning

confidence: 99%

Accidental injury of the latissimus dorsi flap pedicle during axillae dissection: Types and reconstruction algorithm

et al. 2013

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“…Especially the lateral and superior edges of the flap shaping are important for the final shape of the reconstructed breast. The flap is secured on the thoracic wall with multiple Vicryl 2/0 sutures to avoid traction or avulsion of the pedicle, seen its relative short length 15 . Finally, two drains are left in the breast pocket in a criss‐cross fashion.…”

Section: Methodsmentioning

confidence: 99%

“…The flap is secured on the thoracic wall with multiple Vicryl 2/0 sutures to avoid traction or avulsion of the pedicle, seen its relative short length. 15 Finally, two drains are left in the breast pocket in a criss-cross fashion. Donor-site closure is performed during the microsurgery.…”

Section: Banana-shaped Pap Flap For Breast Reconstruction-surgical Techniquementioning

confidence: 99%

Anatomic study of the profunda artery perforators by multidetector CT scanner and clinical use of the banana‐shaped flap design for breast reconstruction

Zeltzer

Waked

Brussaard

et al. 2021

Journal of Surgical Oncology

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Background: The profunda artery perforator (PAP) flap is a well-known free flap for breast reconstruction. However, a reproducible perforator mapping system has yet to be developed. Methods:The PAP perforators were localized by CTA using a novel X-Y axis system.Flap dimensions were based on the CTA images and localized PAP-perforators.Perioperative findings and postoperative outcomes were analyzed.Results: A total of 70 lower limbs and 180 PAP perforators were evaluated. An average of 2.78 ± 1.22 and 2.22 ± 0.96 perforators were seen, in the right and left legs, respectively, and were divided in five clusters (PAP1-PAP5) based on their location on the Y-axis. The course of the perforators was noted as well as the average diameter at the origin. The overall average diameter was 1.99 ± 0.86 mm. A banana-shaped PAP-flap was harvested in 10 patients. The mean operative time was 278 min, pedicle length 76 ± 12 mm, and mean flap weight 247 g. No major complications were seen. Conclusion:The PAP flap can be mapped by CTA in a reproducible way. The X and Y axes are based on fixed anatomic landmarks and may form the basis for a bananashaped flap design of the PAP-flap.

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Accidental latissimus dorsi flap pedicle avulsion during immediate breast reconstruction: Salvage by conversion to free flap

Martano

Malata

2012

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Vascular pedicle avulsion in free flap breast reconstruction: A case of diep flap salvage following early avulsion of venous anastomosis and literature review

Cited by 5 publications

References 28 publications

Accidental injury of the latissimus dorsi flap pedicle during axillae dissection: Types and reconstruction algorithm

Accidental injury of the latissimus dorsi flap pedicle during axillae dissection: Types and reconstruction algorithm

Anatomic study of the profunda artery perforators by multidetector CT scanner and clinical use of the banana‐shaped flap design for breast reconstruction

Accidental latissimus dorsi flap pedicle avulsion during immediate breast reconstruction: Salvage by conversion to free flap

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