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Case 3.8
Published in Monica Fawzy, Plastic Surgery Vivas for the FRCS(Plast), 2023
This patient has undergone a DIEP flap reconstruction. Tell me – how does a microvascular anastomosis heal?Following completion of the anastomosis, platelets cover endothelial breaches immediately, and disappear between the 1st day and 3rd day provided that collagen within the media is not exposed.A pseudo-intima forms over the first 5 days, witha new endothelial layer within the first 1–2 weeks.
Standard autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
The DIEP flap is the gold standard autologous breast reconstructive option. It can be used in immediate and delayed breast reconstruction and for correction of failed implant-based reconstruction. The DIEP flap provides a consistent and reliable method of creating a breast mound which is long-lasting and natural in appearance, limiting abdominal wall morbidity, and often improving abdominal contour (Figure 22.5.10).
Reconstructive Microsurgery in Head and Neck Surgery
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
John C. Watkinson, Ralph W. Gilbert
The rectus abdominus myocutaneous flap has been widely used in head and neck reconstruction. Its major applications have been in large volume reconstructions of the oral cavity or oropharynx and lateral skull base. The volume of tissue and the combination of muscle and skin offer the reconstructive surgeon the ability to fill surgical dead space and protect critical structures such as the carotid sheath or dural repairs. The flap is particularly useful for the total glossectomy defect where the volume of tissue can fill the space under the mandible, reducing the risk of perioperative fistula and infectious complications. The perforator-based DIEP flap extends the use of this flap, as the ability to harvest a large cutaneous flap, without the associated muscle, makes it useful for total glossectomy and extensive tongue defects. The DIEP flap can also be used to cover extensive facial and neck defects and may be used to recontour soft tissue defects of the lateral face.
Evaluation of an assessment scale for aesthetic outcome in breast reconstructions based on digital photos in both 2D and 3D format
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Linda Tallroth, Nathalie Mobargha, Patrik Velander, Stina Klasson, Magnus Becker
Although a low number of patients were included in this study, the results tended to be in favour of the DIEP flap breast reconstructions due to the better aesthetic outcome. Superior aesthetic outcome in autologous reconstruction compared with implant-based reconstructions has been reported previously [21–23]. The difference in aesthetic outcome between the reconstruction methods may increase with time as autologous reconstructions tend to be stable over time, unlike implants. Thus, other treatments and patient characteristics may influence the aesthetic outcome. Radiation therapy had a negative effect on the overall aesthetic outcome in a study by Huis et al. [6]. In addition, higher BMI and reoperations due to complications have also been reported to negatively affect aesthetics [21]. An in-depth review of our study material supports these results as some of the patients with low overall aesthetic outcome had been through reoperations due to complications, and in one case had a large increase in BMI. However, these associations must be confirmed in a larger body of material.
Indocyanine Green Angiography for Continuously Monitoring Blood Flow Changes and Predicting Perfusion of Deep Inferior Epigastric Perforator Flap in Rats
Published in Journal of Investigative Surgery, 2021
The DIEP flap, also known as muscle-sparing type flap, is a breast reconstruction technique in which skin containing axial blood supply is taken from the abdomen to recreate the breast. Considering the DIEP flap consists of only a few perforating vessels, this technique induces minimal damage to the rectus abdominis and the front rectus sheath. Nevertheless, difficulties in flap harvesting and high risks of partial flap necrosis related to the arterial and the venous problems have been well documented [1–3]. Taylor’s choke vessel theory is an important principle to follow in flap design, which could provide a rational explanation for the arterial related flap necrosis [4]. Yet, so far no flap model has been created that would allow for direct observation of the proposed procedure. Previously, Oksar et al. have designed a rat abdominal pedicle flap model using the superior abdominal perforating blood vessels. Even though the perfusion of the DIEP flap has been widely studied [5], most of the previous studies have focused on static or discontinuous methods [6–8].
Factors that predict deep inferior epigastric perforator flap donor site hernia and bulge
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Daniel P. Butler, Agata M. Plonczak, Dimitris Reissis, Francis P. Henry, Judith E. Hunter, Simon H. Wood, Navid Jallali
A retrospective analysis of all patients undergoing DIEP flap breast reconstruction between January 2012 and March 2016 was performed. Patient and surgical variables were collected to allow for comparison in the donor site morbidity due to different variables. Surgery was performed by one of three experienced microsurgical consultants (JH/NJ/SW). All patients underwent a pre-operative computed tomography angiogram to evaluate the abdominal wall vasculature and aid surgical planning. A suitable perforator was considered as one with a diameter >1.5 mm and a strong Doppler signal. More than one perforator was taken in patients to avoid fat necrosis where no single perforator was judged to be sufficient to provide adequate vascularity to the flap. Where possible and appropriate, a medial row perforator was prefentially selected. Surgical judgement on the appearance, pulsatility, location and suprafascial perforator course then determined final perforator selection. The rectus fascia was closed using one of three techniques:Two-layer closure using looped 0 Ethilon and underlay Prolene mesh.Double-breasted closure with bidirectional Stratafix barbed suture.Double-breasted closure with bidirectional Stratafix barbed suture and underlay Prolene mesh.