Various modifications to internal mammary vessel anastomosis in breast reconstruction with deep inferior epigastric perforator flap

Chen-Kun Chen, Hao-Chih Tai, Hsiung-Fei Chien, Yueh-Bih Tang Chen

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Free autologous tissue transfer has been used in mastectomized patients for high-quality reconstruction. Since the deep inferior epigastric perforator flap was developed, it has been considered preferable owing to reduced donor site morbidity. At our institution, anastomosis of internal mammary vessels has been top priority because of better positioning and shorter pedicle length. We publish our experiences with various technical modifications that assure internal mammary vessel anastomosis. From 2003 to 2008, 35 patients received free deep inferior epigastric perforator flap for breast reconstruction by anastomosis with internal mammary vessels. Twenty-nine reconstructions were done immediately upon mastectomy whereas six were delayed. The patterns of anastomosis between the flap pedicle and internal mammary vessel were categorized and the results were followed by flap survival and complications. These deep inferior epigastric perforator flaps were all supplied by a single pedicle artery. Twenty-five of them were drained by a single pedicle vein, and the venous anastomosis pattern was end to end to the single internal mammary vein (IMV) (type I, n=25). However, the other nine flaps were drained by one pedicle vein anastomosed end to end to double IMV (type II, n=2), end to end to both proximal and distal ends of single IMV (type III, n=5), end to end and end to side to single IMV (type IV, n=2), and end to end to single IMV without anastomosing the other (type V, n=1). All flaps were successful, except in one patient with type I anastomosis who received vascular reexploration due to pedicle twisting. Another patient with type I anastomosis needed revision due to partial fat necrosis of the flap. No other complications were found. Various modifications of internal mammary vessel anastomosis can be used to ensure the safety of deep inferior epigastric perforator flap in breast reconstruction. Copyright © 2010 by Thieme Medical Publishers, Inc.
Original languageEnglish
Pages (from-to)219-223
Number of pages5
JournalJournal of Reconstructive Microsurgery
Volume26
Issue number4
DOIs
Publication statusPublished - 2010
Externally publishedYes

Fingerprint

Perforator Flap
Mammaplasty
Breast
Veins
Fat Necrosis
Mastectomy
Blood Vessels
Arteries
Tissue Donors

Keywords

  • DIEP
  • Internal mammary vessels
  • Vascular anastomosis
  • adult
  • anastomosis
  • article
  • breast reconstruction
  • clinical article
  • controlled study
  • human
  • internal mammary artery
  • mastectomy
  • outcome assessment
  • perforator flap
  • position
  • priority journal
  • surgical technique
  • vascular pedicle
  • abdominal wall
  • aged
  • Breast Neoplasms
  • epigastric artery
  • female
  • follow up
  • graft rejection
  • graft survival
  • mammary artery
  • microsurgery
  • middle aged
  • pathophysiology
  • postoperative complication
  • procedures
  • risk assessment
  • treatment outcome
  • vascularization
  • Abdominal Wall
  • Aged
  • Anastomosis, Surgical
  • Epigastric Arteries
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Humans
  • Mammaplasty
  • Mammary Arteries
  • Mastectomy
  • Microsurgery
  • Middle Aged
  • Postoperative Complications
  • Risk Assessment
  • Treatment Outcome

Cite this

Various modifications to internal mammary vessel anastomosis in breast reconstruction with deep inferior epigastric perforator flap. / Chen, Chen-Kun; Tai, Hao-Chih; Chien, Hsiung-Fei; Chen, Yueh-Bih Tang.

In: Journal of Reconstructive Microsurgery, Vol. 26, No. 4, 2010, p. 219-223.

Research output: Contribution to journalArticle

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abstract = "Free autologous tissue transfer has been used in mastectomized patients for high-quality reconstruction. Since the deep inferior epigastric perforator flap was developed, it has been considered preferable owing to reduced donor site morbidity. At our institution, anastomosis of internal mammary vessels has been top priority because of better positioning and shorter pedicle length. We publish our experiences with various technical modifications that assure internal mammary vessel anastomosis. From 2003 to 2008, 35 patients received free deep inferior epigastric perforator flap for breast reconstruction by anastomosis with internal mammary vessels. Twenty-nine reconstructions were done immediately upon mastectomy whereas six were delayed. The patterns of anastomosis between the flap pedicle and internal mammary vessel were categorized and the results were followed by flap survival and complications. These deep inferior epigastric perforator flaps were all supplied by a single pedicle artery. Twenty-five of them were drained by a single pedicle vein, and the venous anastomosis pattern was end to end to the single internal mammary vein (IMV) (type I, n=25). However, the other nine flaps were drained by one pedicle vein anastomosed end to end to double IMV (type II, n=2), end to end to both proximal and distal ends of single IMV (type III, n=5), end to end and end to side to single IMV (type IV, n=2), and end to end to single IMV without anastomosing the other (type V, n=1). All flaps were successful, except in one patient with type I anastomosis who received vascular reexploration due to pedicle twisting. Another patient with type I anastomosis needed revision due to partial fat necrosis of the flap. No other complications were found. Various modifications of internal mammary vessel anastomosis can be used to ensure the safety of deep inferior epigastric perforator flap in breast reconstruction. Copyright {\circledC} 2010 by Thieme Medical Publishers, Inc.",
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author = "Chen-Kun Chen and Hao-Chih Tai and Hsiung-Fei Chien and Chen, {Yueh-Bih Tang}",
note = "被引用次數:3 Export Date: 16 March 2016 CODEN: JRMIE 通訊地址: Chen, Y.-B. T.; Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, No. 7, Jhongshan S. Road, Jhongjheng District, Taipei 100, Taiwan; 電子郵件: phoebetang@ntu.edu.tw 參考文獻: Shaw, W.W., Microvascular free flap breast reconstruction (1984) Clin Plast Surg, 11, pp. 333-341; Elliott, L.F., Hartrampf, Jr.C.R., Breast reconstruction: Progress in the past decade (1990) World J Surg, 14, pp. 763-775; Beckenstein, M.S., Grotting, J.C., Breast reconstruction with free-tissue transfer (2001) Plast Reconstr Surg, 108, pp. 1345-1353. , quiz 1354; Gill, P.S., Hunt, J.P., Guerra, A.B., A 10-year retrospective review of 758 DIEP flaps for breast reconstruction (2004) Plast Reconstr Surg, 113, pp. 1153-1160; Dupin, C.L., Allen, R.J., Glass, C.A., Bunch, R., The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: A report of 110 consecutive cases (1996) Plast Reconstr Surg, 98, pp. 685-689. , discussion 690-692; Feng, L.J., Recipient vessels in free-flap breast reconstruction: A study of the internal mammary and thoracodorsal vessels (1997) Plast Reconstr Surg, 99, pp. 405-416; Robb, G.L., Thoracodorsal vessels as a recipient site (1998) Clin Plast Surg, 25, pp. 207-211; Lindsey, J.T., Integrating the DIEP and muscle-sparing (MS-2) free TRAM techniques optimizes surgical outcomes: Presentation of an algorithm for microsurgical breast reconstruction based on perforator anatomy (2007) Plast Reconstr Surg, 119, pp. 18-27; Rowsell, A.R., Davies, D.M., Eisenberg, N., Taylor, G.I., The anatomy of the subscapular-thoracodorsal arterial system: Study of 100 cadaver dissections (1984) Br J Plast Surg, 37, pp. 574-576; Quaba, O., Brown, A., Stevenson, H., Internal mammary vessels, recipient vessels of choice for free tissue breast reconstruction? (2005) Br J Plast Surg, 58, pp. 881-882; Hamdi, M., Blondeel, P., Van Landuyt, K., Monstrey, S., Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: The role of the internal mammary perforators (2004) Br J Plast Surg, 57, pp. 258-265; Haywood, R.M., Raurell, A., Perks, A.G., Sassoon, E.M., Logan, A.M., Phillips, J., Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels (2003) Br J Plast Surg, 56, pp. 689-691; Majumder, S., Batchelor, A.G., Internal mammary vessels as recipients for free TRAM breast reconstruction: Aesthetic and functional considerations (1999) Br J Plast Surg, 52, pp. 286-289; Park, M.C., Lee, J.H., Chung, J., Lee, S.H., Use of internal mammary vessel perforator as a recipient vessel for free TRAM breast reconstruction (2003) Ann Plast Surg, 50, pp. 132-137",
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TY - JOUR

T1 - Various modifications to internal mammary vessel anastomosis in breast reconstruction with deep inferior epigastric perforator flap

AU - Chen, Chen-Kun

AU - Tai, Hao-Chih

AU - Chien, Hsiung-Fei

AU - Chen, Yueh-Bih Tang

N1 - 被引用次數:3 Export Date: 16 March 2016 CODEN: JRMIE 通訊地址: Chen, Y.-B. T.; Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, No. 7, Jhongshan S. Road, Jhongjheng District, Taipei 100, Taiwan; 電子郵件: phoebetang@ntu.edu.tw 參考文獻: Shaw, W.W., Microvascular free flap breast reconstruction (1984) Clin Plast Surg, 11, pp. 333-341; Elliott, L.F., Hartrampf, Jr.C.R., Breast reconstruction: Progress in the past decade (1990) World J Surg, 14, pp. 763-775; Beckenstein, M.S., Grotting, J.C., Breast reconstruction with free-tissue transfer (2001) Plast Reconstr Surg, 108, pp. 1345-1353. , quiz 1354; Gill, P.S., Hunt, J.P., Guerra, A.B., A 10-year retrospective review of 758 DIEP flaps for breast reconstruction (2004) Plast Reconstr Surg, 113, pp. 1153-1160; Dupin, C.L., Allen, R.J., Glass, C.A., Bunch, R., The internal mammary artery and vein as a recipient site for free-flap breast reconstruction: A report of 110 consecutive cases (1996) Plast Reconstr Surg, 98, pp. 685-689. , discussion 690-692; Feng, L.J., Recipient vessels in free-flap breast reconstruction: A study of the internal mammary and thoracodorsal vessels (1997) Plast Reconstr Surg, 99, pp. 405-416; Robb, G.L., Thoracodorsal vessels as a recipient site (1998) Clin Plast Surg, 25, pp. 207-211; Lindsey, J.T., Integrating the DIEP and muscle-sparing (MS-2) free TRAM techniques optimizes surgical outcomes: Presentation of an algorithm for microsurgical breast reconstruction based on perforator anatomy (2007) Plast Reconstr Surg, 119, pp. 18-27; Rowsell, A.R., Davies, D.M., Eisenberg, N., Taylor, G.I., The anatomy of the subscapular-thoracodorsal arterial system: Study of 100 cadaver dissections (1984) Br J Plast Surg, 37, pp. 574-576; Quaba, O., Brown, A., Stevenson, H., Internal mammary vessels, recipient vessels of choice for free tissue breast reconstruction? (2005) Br J Plast Surg, 58, pp. 881-882; Hamdi, M., Blondeel, P., Van Landuyt, K., Monstrey, S., Algorithm in choosing recipient vessels for perforator free flap in breast reconstruction: The role of the internal mammary perforators (2004) Br J Plast Surg, 57, pp. 258-265; Haywood, R.M., Raurell, A., Perks, A.G., Sassoon, E.M., Logan, A.M., Phillips, J., Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels (2003) Br J Plast Surg, 56, pp. 689-691; Majumder, S., Batchelor, A.G., Internal mammary vessels as recipients for free TRAM breast reconstruction: Aesthetic and functional considerations (1999) Br J Plast Surg, 52, pp. 286-289; Park, M.C., Lee, J.H., Chung, J., Lee, S.H., Use of internal mammary vessel perforator as a recipient vessel for free TRAM breast reconstruction (2003) Ann Plast Surg, 50, pp. 132-137

PY - 2010

Y1 - 2010

N2 - Free autologous tissue transfer has been used in mastectomized patients for high-quality reconstruction. Since the deep inferior epigastric perforator flap was developed, it has been considered preferable owing to reduced donor site morbidity. At our institution, anastomosis of internal mammary vessels has been top priority because of better positioning and shorter pedicle length. We publish our experiences with various technical modifications that assure internal mammary vessel anastomosis. From 2003 to 2008, 35 patients received free deep inferior epigastric perforator flap for breast reconstruction by anastomosis with internal mammary vessels. Twenty-nine reconstructions were done immediately upon mastectomy whereas six were delayed. The patterns of anastomosis between the flap pedicle and internal mammary vessel were categorized and the results were followed by flap survival and complications. These deep inferior epigastric perforator flaps were all supplied by a single pedicle artery. Twenty-five of them were drained by a single pedicle vein, and the venous anastomosis pattern was end to end to the single internal mammary vein (IMV) (type I, n=25). However, the other nine flaps were drained by one pedicle vein anastomosed end to end to double IMV (type II, n=2), end to end to both proximal and distal ends of single IMV (type III, n=5), end to end and end to side to single IMV (type IV, n=2), and end to end to single IMV without anastomosing the other (type V, n=1). All flaps were successful, except in one patient with type I anastomosis who received vascular reexploration due to pedicle twisting. Another patient with type I anastomosis needed revision due to partial fat necrosis of the flap. No other complications were found. Various modifications of internal mammary vessel anastomosis can be used to ensure the safety of deep inferior epigastric perforator flap in breast reconstruction. Copyright © 2010 by Thieme Medical Publishers, Inc.

AB - Free autologous tissue transfer has been used in mastectomized patients for high-quality reconstruction. Since the deep inferior epigastric perforator flap was developed, it has been considered preferable owing to reduced donor site morbidity. At our institution, anastomosis of internal mammary vessels has been top priority because of better positioning and shorter pedicle length. We publish our experiences with various technical modifications that assure internal mammary vessel anastomosis. From 2003 to 2008, 35 patients received free deep inferior epigastric perforator flap for breast reconstruction by anastomosis with internal mammary vessels. Twenty-nine reconstructions were done immediately upon mastectomy whereas six were delayed. The patterns of anastomosis between the flap pedicle and internal mammary vessel were categorized and the results were followed by flap survival and complications. These deep inferior epigastric perforator flaps were all supplied by a single pedicle artery. Twenty-five of them were drained by a single pedicle vein, and the venous anastomosis pattern was end to end to the single internal mammary vein (IMV) (type I, n=25). However, the other nine flaps were drained by one pedicle vein anastomosed end to end to double IMV (type II, n=2), end to end to both proximal and distal ends of single IMV (type III, n=5), end to end and end to side to single IMV (type IV, n=2), and end to end to single IMV without anastomosing the other (type V, n=1). All flaps were successful, except in one patient with type I anastomosis who received vascular reexploration due to pedicle twisting. Another patient with type I anastomosis needed revision due to partial fat necrosis of the flap. No other complications were found. Various modifications of internal mammary vessel anastomosis can be used to ensure the safety of deep inferior epigastric perforator flap in breast reconstruction. Copyright © 2010 by Thieme Medical Publishers, Inc.

KW - DIEP

KW - Internal mammary vessels

KW - Vascular anastomosis

KW - adult

KW - anastomosis

KW - article

KW - breast reconstruction

KW - clinical article

KW - controlled study

KW - human

KW - internal mammary artery

KW - mastectomy

KW - outcome assessment

KW - perforator flap

KW - position

KW - priority journal

KW - surgical technique

KW - vascular pedicle

KW - abdominal wall

KW - aged

KW - Breast Neoplasms

KW - epigastric artery

KW - female

KW - follow up

KW - graft rejection

KW - graft survival

KW - mammary artery

KW - microsurgery

KW - middle aged

KW - pathophysiology

KW - postoperative complication

KW - procedures

KW - risk assessment

KW - treatment outcome

KW - vascularization

KW - Abdominal Wall

KW - Aged

KW - Anastomosis, Surgical

KW - Epigastric Arteries

KW - Female

KW - Follow-Up Studies

KW - Graft Rejection

KW - Graft Survival

KW - Humans

KW - Mammaplasty

KW - Mammary Arteries

KW - Mastectomy

KW - Microsurgery

KW - Middle Aged

KW - Postoperative Complications

KW - Risk Assessment

KW - Treatment Outcome

U2 - 10.1055/s-0030-1248229

DO - 10.1055/s-0030-1248229

M3 - Article

VL - 26

SP - 219

EP - 223

JO - Journal of Reconstructive Microsurgery

JF - Journal of Reconstructive Microsurgery

SN - 0743-684X

IS - 4

ER -