J 2023

An Algorithm in Managing Deep Inferior Epigastric Vessel Interruption in Free Flap Breast Reconstruction

KAPILA, Ayush K, Tomáš KEMPNÝ, Martin KNOZ, Jakub HOLOUBEK, Břetislav LIPOVÝ et. al.

Základní údaje

Originální název

An Algorithm in Managing Deep Inferior Epigastric Vessel Interruption in Free Flap Breast Reconstruction

Autoři

KAPILA, Ayush K (garant), Tomáš KEMPNÝ (203 Česká republika), Martin KNOZ (203 Česká republika, domácí), Jakub HOLOUBEK (203 Česká republika, domácí), Břetislav LIPOVÝ (203 Česká republika, domácí) a Moustapha HAMDI

Vydání

Plastic and reconstructive surgery. Global open, PHILADELPHIA, LIPPINCOTT WILLIAMS & WILKINS, 2023, 2169-7574

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30212 Surgery

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

Impakt faktor

Impact factor: 1.500 v roce 2022

Kód RIV

RIV/00216224:14110/23:00130596

Organizační jednotka

Lékařská fakulta

DOI

UT WoS

000962969600006

Klíčová slova anglicky

Deep Inferior Epigastric Vessel Interruption; Free Flap Breast Reconstruction; Algorithm

Štítky

Příznaky

Mezinárodní význam, Recenzováno
Změněno: 11. 7. 2023 10:59, Mgr. Tereza Miškechová

Anotace

V originále

Background: Previous surgical procedures in the abdomen are no longer contra-indications for free flap breast reconstruction using the deep inferior epigastric artery perforator flap. Nonetheless, a possible consequence of previous surgical procedures may be trauma to the deep inferior epigastric (DIE) pedicle, leading to interruption. In these cases, a modification in operative strategy may be required. Methods: A study was performed across two centers, during a 10-year period between January 1, 2010 and December 2019. Patient and outcome data were collected from the patient file and operation notes. Results: Four cases with clear evidence of DIE pedicle interruption were found, with an average age of 54 years and an average body mass index of 28.9. Three patients had a preoperative diagnosis of DIE pedicle interruption on CT angiography, whereas in one case this was found peroperatively. For three cases, unilateral reconstruction was performed, and for one, bilateral reconstruction. Four flaps (in three cases) were unipedicled; the contralateral DIE pedicle was used in three, and the superficial system was used in one. For the bipedicled case, two hemiflaps were used, with the interrupted DIE pedicle anastomosed to a branch of the contralateral DIE pedicle. Conclusions: Interrupted DIE vessels remain a challenge for free flap breast reconstruction. The four cases demonstrated in this article highlight different surgical strategies, with an emphasis on detailed preoperative planning, including CT angiography. We present an algorithm to aid the reader in approaching cases with an interrupted DIE pedicle.