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Deep inferior epigastric

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https://www.readbyqxmd.com/read/28108115/a-reappraisal-of-the-surgical-planning-of-the-superficial-circumflex-iliac-artery-perforator-flap
#1
Shaoqing Feng, Wenjing Xi, Zheng Zhang, Mathias Tremp, Dirk J Schaefer, Parviz L Sadigh, Wenjie Zhang, Yi Xin Zhang
OBJECTIVE: The popularity of the superficial circumflex iliac artery perforator (SCIP) flap has been limited by factors such as variable vascular anatomy and short arterial pedicle. This article aimed to delineate flap design and harvest strategies based around either the proximal or distal perforators of the superficial circumflex iliac artery (SCIA) and propose a set of strategies that can help deal with the limitations of the flap. METHOD: From August 2011 to June 2015, the SCIP flap was used in 80 patients for soft tissue defects at our institution...
December 22, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28092334/is-enhanced-recovery-the-new-standard-of-care-in-microsurgical-breast-reconstruction
#2
Anoushka Afonso, Sabine Oskar, Kay See Tan, Joseph J Disa, Babak J Mehrara, Jihan Ceyhan, Joseph H Dayan
BACKGROUND: Enhanced recovery pathways (ERPs) have been shown to aid in patient recovery and improve outcomes in many surgical settings. At present, there is limited data available regarding the use and feasibility of ERPs for patients undergoing microsurgical breast reconstruction. We sought to assess patient outcomes before and after the introduction of an ERP that was adopted by multiple surgeons at a single cancer center. METHODS: A multidisciplinary ERP was developed for patients undergoing deep inferior epigastric perforator (DIEP) or muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction...
January 12, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28079533/national-and-regional-differences-in-32-248-postmastectomy-autologous-breast-reconstruction-using-the-updated-national-inpatient-survey
#3
Parisa Kamali, Marek A Paul, Ahmed M S Ibrahim, Pieter G L Koolen, Winona Wu, Marc L Schermerhorn, Bernard T Lee, Samuel J Lin
BACKGROUND: The incidence of breast cancer (BC) cases has increased significantly. The number of breast reconstruction (BR) procedures performed has mirrored this trend. Although implant-only procedures remain the most commonly used type of immediate BR, autologous techniques involving donor sites account for approximately 20%. The aim of this study was to assess national and regional trends in different types of autologous BR. METHODS: Using the Nationwide Inpatient Sample database (2008 to 2012), data on BC and mastectomy rates, type of autologous BR, and sociodemographics were obtained and analyzed...
January 10, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28074458/endovascular-treatment-of-peripheral-and-visceral-arterial-injuries-in-patients-with-acute-trauma
#4
Aysun Erbahçeci Salık, Filiz Saçan İslim, Barbaros Erhan Çil
BACKGROUND: The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt trauma. METHODS: Twelve patients (11 men) aged 35.8±11.3 years (range: 18-56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed...
November 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28059854/perforator-phase-contrast-angiography-of-deep-inferior-epigastric-perforators-a-better-preoperative-imaging-tool-for-flap-surgery-than-computed-tomographic-angiography
#5
Xiangyu Yang, Michael J Miller, Harry T Friel, Allison Slijepcevic, Michael V Knopp
OBJECTIVE: The aim of this study was to demonstrate the feasibility of in vivo perforator visualization by a newly proposed magnetic resonance-based perforator phase contrast angiography (pPCA) technique for deep inferior epigastric perforator (DIEP) flap surgery and to prospectively compare its image quality and clinical value with computed tomographic angiography (CTA), the state-of-the-art perforator imaging technique. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained...
January 4, 2017: Investigative Radiology
https://www.readbyqxmd.com/read/28052051/deep-inferior-epigastric-perforator-versus-free-transverse-rectus-abdominis-myocutaneous-flap-complications-and-resource-utilization
#6
Yasmina Zoghbi, David J Gerth, Jun Tashiro, Samuel Golpanian, Seth R Thaller
INTRODUCTION: Abdominal based breast reconstruction exists in a continuum from pedicled transverse rectus abdominis myocutaneous (TRAM) flap to deep inferior epigastric perforator (DIEP) free flap. DIEP flap has the advantage of complete rectus abdominis sparing during harvest, thus decreasing donor site morbidity. Aim of this study is to determine whether the surgical advantages of the DIEP flap impact postoperative outcomes versus the free TRAM flap (fTRAM). METHODS: We reviewed the Nationwide Inpatient Sample database (2010-2011) for all cases of DIEP and fTRAM breast reconstruction...
November 3, 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28032178/comparison-of-aesthetic-outcomes-between-vertical-and-horizontal-flap-insets-in-breast-reconstruction-with-the-tram-or-diep-flaps
#7
Woo Shik Jeong, Wooyeon Han, Jin Sup Eom
BACKGROUND: Tissue transfer, such as use of the transverse rectus abdominis myocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) free flaps, is considered a standard method. However, outcomes may vary among inset methods. Here we compared the aesthetic outcomes of breast reconstructions using vertical and horizontal flap inset methods. METHODS: We, respectively, reviewed 274 patients who underwent unilateral post-mastectomy breast reconstruction using TRAM or DIEP free flaps between April 2006 and December 2013...
December 28, 2016: Aesthetic Plastic Surgery
https://www.readbyqxmd.com/read/28031664/using-a-single-internal-mammary-artery-as-retrograde-and-antegrade-flow-for-bilateral-deep-inferior-epigastric-artery-perforator-reconstruction-a-case-report
#8
Richard Tyrell, Rachelle Y Leong, Sandeep A Sathyanarayana, Peter Korn, Alan S Kadison
Deep inferior epigastric artery perforator (DIEP) flaps have become an attractive option for autologous breast reconstruction. The internal mammary artery (IMA) is the usual artery of choice for reconstruction. Unfortunately, there are certain situations when the IMA may not be suitable for usage as in previous radiation or diminutive size. Several options have been documented, such as using the thoracodorsal vessels. In this case report, we report usage of the distal and proximal ends of a contralateral single mammary artery to supply antegrade and retrograde flow to bilateral DIEP flaps...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/28029602/use-of-both-antegrade-and-retrograde-internal-mammary-vessels-in-the-bipedicled-deep-inferior-epigastric-perforator-flap-for-unilateral-breast-reconstruction
#9
Jonatan Hernandez Rosa, Rami D Sherif, Philip J Torina, Marco A Harmaty
BACKGROUND: Autologous abdominal tissue transfer is a well-established method of breast reconstruction. The deep inferior epigastric perforator (DIEP) flap has the additional benefit of minimal donor site morbidity as it spares the muscle and fascia. Conventional DIEP flaps may not provide adequate volume in cases where the patient is thin, has midline abdominal scars, and/or has a large volume of tissue to replace. One solution is to use a bipedicled DIEP flap, incorporating all the available abdominal tissue...
September 20, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28024853/inferior-vena-cava-compression-as-a-novel-maneuver-to-detect-patent-foramen-ovale-a%C3%A2-transesophageal-echocardiographic-study
#10
Eiji Yamashita, Tomoyuki Murata, Eri Goto, Takeshi Fujiwara, Takehito Sasaki, Kentaro Minami, Kohki Nakamura, Koji Kumagai, Shigeto Naito, Kazuomi Kario, Shigeru Oshima
BACKGROUND: The Valsalva maneuver, the most sensitive test for patent foramen ovale (PFO) detection, is difficult during transesophageal echocardiography (TEE), especially after sedation. The aim of this study was to compare PFO detection effectiveness between inferior vena cava (IVC) compression and the Valsalva maneuver. METHODS: A total of 293 patients with paroxysmal atrial fibrillation undergoing TEE before initial atrial fibrillation ablation were prospectively enrolled...
December 23, 2016: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28017260/comparison-of-dissection-with-harmonic-scalpel-and-conventional-bipolar-electrocautery-in-deep-inferior-epigastric-perforator-flap-surgery-a-consecutive-cohort-study
#11
Yoon Jae Lee, Hak Young Kim, Hyun Ho Han, Suk-Ho Moon, Jun Hee Byeon, Jong Won Rhie, Sang Tae Ahn, Deuk Young Oh
Reduced tissue damage is a theoretical advantage of using an ultrasonic harmonic scalpel. We hypothesized that the harmonic scalpel would outperform electrocautery in deep inferior epigastric perforator flap surgery, possibly resulting in a shorter operative time and reduced postoperative drainage and pain. Between January and August 2015, 24 consecutive patients were assigned to immediate deep inferior epigastric perforator flap elevation (12 for bipolar electrocautery and 12 for harmonic scalpel). The main outcome variables were total operative time, flap elevation time (starting from the fascia incision), and drainage volume...
November 20, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27996199/chronic-postsurgical-pain-outcomes-in-breast-reconstruction-patients-receiving-perioperative-transversus-abdominis-plane-catheters-at-the-donor-site-a-prospective-cohort-follow-up-study
#12
Justin Oh, Gabrielle M Pagé, Toni Zhong, Stuart McCluskey, Coimbatore Srinivas, Anne C O'Neill, James Kahn, Joel Katz, Stefan O P Hofer, Hance Clarke
BACKGROUND: Chronic postsurgical pain (CPSP) is a debilitating and costly condition. Risk factors for CPSP after autologous breast reconstruction have not been clearly established. Previously, we demonstrated that transversus abdominis plane (TAP) catheters delivering intermittent local anesthetic reduced postoperative morphine consumption. This prospective follow-up study aims to (1) compare the incidence of CPSP after autologous breast reconstruction between patients who received postoperative intermittent TAP catheters with bupivacaine or saline boluses and (2) assess the factors that contribute to the development and maintenance of CPSP in this study cohort...
December 20, 2016: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/27919113/analysis-of-flap-weight-and-postoperative-complications-based-on-flap-weight-in-patients-undergoing-microsurgical-breast-reconstruction
#13
Gretl Lam, Katie E Weichman, Patrick L Reavey, Stelios C Wilson, Jamie P Levine, Pierre B Saadeh, Robert J Allen, Mihye Choi, Nolan S Karp, Vishal D Thanik
Background Higher body mass index (BMI) has been shown to increase postoperative complications in autologous breast reconstruction. However, the correlation with flap weight is unknown. Here, we explore the relationship of flap weights and complication rates in patients undergoing microvascular breast reconstruction. Methods Retrospective chart review identified all patients undergoing microvascular breast reconstruction with abdominally based flaps at a single institution between November 2007 and April 2013...
December 5, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27906762/complications-in-postmastectomy-breast-reconstruction-one-year-outcomes-of-the-mastectomy-reconstruction-outcomes-consortium-mroc-study
#14
Edwin G Wilkins, Jennifer B Hamill, Hyungjin M Kim, John Y Kim, Richard J Greco, Ji Qi, Andrea L Pusic
OBJECTIVE: In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. This study sought to evaluate complications in a large, multicenter patient population. SUMMARY OF BACKGROUND DATA: Previous studies have reported widely varying complication rates, but have been limited by their single center designs and inadequate controlling for confounders in their analyses. METHODS: Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction following mastectomy for cancer treatment or prophylaxis...
November 30, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/27894571/pre-expanded-deep-inferior-epigastric-perforator-flap
#15
REVIEW
Sharon E Monsivais, Nicholas D Webster, Stacy Wong, Michel H Saint-Cyr
The deep inferior epigastric perforator (DIEP) flap can be used to cover large defects of the proximal lower extremity, abdominal wall, perineum, vulva, and buttock. Pre-expanding DIEP flaps cause a possible delay phenomenon improving vascularity, decrease donor site morbidity, and increase the area that can be covered. Pre-expansion requires staged procedures, has risk of extrusion and infection, causes temporary contour deformity during the expansion process, and requires a longer course. Pre-expanded DIEP flaps can be a useful flap with proper patient selection and planning...
January 2017: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/27894155/increased-lower-extremity-venous-stasis-may-contribute-to-deep-venous-thrombosis-formation-after-microsurgical-breast-reconstruction-an-ultrasonographic-study
#16
Arash Momeni, Michael G Tecce, Michael A Lanni, Shagun Aggarwal, Christopher Pannucci, Stephen J Kovach, Suhail K Kanchwala, Liza C Wu, Joseph M Serletti
Background Despite guideline-compliant prophylaxis, an increased rate of deep venous thrombosis (DVT) formation has been reported following autologous versus implant-based breast reconstruction. We hypothesized that tight abdominal fascia closure might decrease lower extremity venous return and promote venous stasis. Methods An observational crossover study of patients who underwent autologous breast reconstruction using transverse rectus abdominis musculocutaneous/deep inferior epigastric artery perforator flaps was conducted...
November 28, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27887016/inferior-vena-caval-filter-strut-perforation-causing-intramural-duodenal-haematoma
#17
Zoheb Berry Williams, Nicole M Organ, Stephen Deane
We present a case of intramural duodenal haematoma caused by inferior vena caval (IVC) filter strut perforation requiring innovative open and endovascular retrieval. A 32-year-old woman presents in shock with dull epigastric pain and non-bilious vomiting. She had previously had an IVC filter for deep venous thrombosis and pulmonary embolism. Computed tomography demonstrated strut perforation into the second part of the duodenum, causing intramural haematoma and duodenal obstruction. Laparotomy facilitated evacuation of the duodenal haematoma, while the IVC filter was retrieved by endovascular means...
November 24, 2016: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/27885675/intratissue-lymphovenous-communications-in-the-mechanism-of-action-of-vascularized-lymph-node-transfer
#18
María Miranda Garcés, Gemma Pons, Rosa Mirapeix, Jaume Masià
BACKGROUND AND OBJECTIVES: Vascularized lymph node transfer (VLNT) as a surgical treatment for cancer-related lymphedema has shown beneficial effects. The mechanism of action of this procedure involves lymphangiogenesis and lymphovenous communications (LVC) within the lymph nodes. We propose intratissue LVC as an additional element responsible for drainage of lymph to blood in the flap and examine this hypothesis in the current study. METHODS: This prospective study determined the passage of lymph to the venous system via intratissue LVC in 26 free flaps used for breast reconstruction...
November 25, 2016: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/27798424/considering-the-optimal-timing-of-breast-reconstruction-with-abdominal-flaps-with-adjuvant-irradiation-in-370-consecutive-pedicled-transverse-rectus-abdominis-myocutaneous-flap-and-free-deep-inferior-epigastric-perforator-flap-performed-in-a-chinese-oncology
#19
Shanshan He, Jian Yin, Geoffrey L Robb, Jingyan Sun, Xuehui Zhang, Haixin Li, Jing Liu, Chunyong Han
PURPOSE: There is an ongoing debate on the optimal sequence of radiation and breast reconstruction. The purpose of this article was to (a) assess the impact of radiation on autologous breast reconstruction and (b) analyze the best timing for autologous breast reconstruction in the setting of radiation in a Chinese population. METHODS: A retrospective review of patients undergoing breast reconstruction with autologous lower abdominal flaps between 2001 and 2014 in the Tianjin Medical University and Cancer Hospital was performed...
October 28, 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/27782983/techniques-and-perforator-selection-in-single-dominant-diep-flap-breast-reconstruction-algorithmic-approach-to-maximize-efficiency-and-safety
#20
Anita T Mohan, Lin Zhu, Zhen Wang, Aparna Vijayasekaran, Michel Saint-Cyr
BACKGROUND: Perforator selection is critical to deep inferior epigastric perforator (DIEP) flap harvest. Commitment to a single perforator has the potential benefit of a simpler dissection, but may increase fat necrosis or perfusion-related complications compared with multiple perforator harvest. METHODS: A 3-year retrospective study was carried out of all patients who underwent DIEP flap breast reconstruction performed by the senior author (M.S.-C). Data were collected on patient demographics and surgical outcomes...
November 2016: Plastic and Reconstructive Surgery
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