Volume 37 Issue 12
Dec.  2021
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Article Contents
Song DJ,Li Z,Zhang YX,et al.Clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator flap in breast reconstruction[J].Chin J Burns,2021,37(12):1143-1148.DOI: 10.3760/cma.j.cn501120-20200824-00390.
Citation: Song DJ,Li Z,Zhang YX,et al.Clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator flap in breast reconstruction[J].Chin J Burns,2021,37(12):1143-1148.DOI: 10.3760/cma.j.cn501120-20200824-00390.

Clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator flap in breast reconstruction

doi: 10.3760/cma.j.cn501120-20200824-00390
Funds:

Hunan Provincial Health and Family Planning Commission Project B2019092, 20201650, 20200829

Science and Health Planning Project of Hunan Provincial Natural Science Foundation 2018JJ6028, S2018SFYLJS0174

Hunan Technological Innovation Guidance Plan Project 2018SK50906

Basic Research Project of Science and Technology Plan of Changsha City kq1901074, kq1901077

More Information
  • Corresponding author: Li Zan, Email: zzanli@163.com
  • Received Date: 2020-08-24
  •     Objective   To explore the clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator (DIEP) flap in breast reconstruction.    Methods   A retrospective observational study was used. From December 2008 to December 2016, 24 patients who met the inclusion criteria were treated in the Department of Plastic Surgery of Hunan Cancer Hospital, all patients were female, aged 28-51 (36.5±1.6) years. All cases received turbocharged bipedicle DIEP flap for two-staged breast reconstruction. According to the patterns of turbocharged vessels anastomosis, the turbocharged bipedicle DIEP flaps with length of (27.5±0.3) cm and width of (12.8±1.4) cm, were divided into three types: distal end of pedicle anastomosis type, main branch of pedicle anastomosis type, and muscular branch of pedicle anastomosis type. After complete hemostasis in the donor region, the anterior sheath was repaired with intermittent suture, and umbilical reconstruction was completed. Two negative pressure drainage tubes were indwelled, and subcutaneous tissue and skin were sutured layer by layer. The specific ways of vascular anastomosis of the flap pedicle with the internal thoracic vessels of recipient site included anastomosing the proximal end of one artery and one vein, anastomosing the proximal and distal end of one artery and one vein, and anastomosing the proximal end of one artery and two veins. Postoperatively, the survival and blood supply of flaps were observed. The patients were followed up to observe the reconstructed breast shape satisfaction, donor site complications, abdominal wall function, and scar hyperplasia.    Results   All turbocharged bipedicle DIEP flaps for two-staged breast reconstruction survived well, with good blood supply. During follow-up for 14 to 56 (20±6) months, the shape of reconstructed breasts was satisfied. Only linear scar was left in the donor sites of abdomen with no complications, and the function of abdominal wall was not affected.    Conclusions   For patients with clear indications, transplantation of free turbocharged bipedicle DIEP flap is a safe, reliable, and satisfactory choice for breast reconstruction with autologous tissue.

     

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  • [1]
    KoshimaI,MoriguchiT,FukudaH,et al.Free, thinned, paraumbilical perforator-based flaps[J].J Reconstr Microsurg,1991,7(4):313-316.
    [2]
    AllenRJ,TreeceP.Deep inferior epigastric perforator flap for breast reconstruction[J].Ann Plast Surg,1994,32(1):32-38.DOI: 10.1097/00000637-199401000-00007.
    [3]
    宋达疆,李赞,周晓,等.局部晚期乳腺癌切除术后巨大复杂创面的整形外科修复[J].中华整形外科杂志,2018,34(8):630-635.DOI: 10.3760/cma.j.issn.1009-4598.2018.08.011.
    [4]
    SongD,LiuD,PafitanisG,et al.Extensive microsurgical reconstruction of chest wall defects for locally advanced breast cancer: a 10-year single-unit experience[J].Ann Plast Surg,2020,84(3):293-299.DOI: 10.1097/SAP.0000000000002000.
    [5]
    DemiriEC,TsimponisA,PagkalosA,et al.Fat-augmented latissimus dorsi versus deep inferior epigastric perforator flap: comparative study in delayed autologous breast reconstruction[J].J Reconstr Microsurg,2021,37(3):208-215.DOI: 10.1055/s-0040-1716348.
    [6]
    TaylorGI,PalmerJH.The vascular territories (angiosomes) of the body: experimental study and clinical applications[J].Br J Plast Surg,1987,40(2):113-141.DOI: 10.1016/0007-1226(87)90185-8.
    [7]
    MoonHK,TaylorGI.The vascular anatomy of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system[J].Plast Reconstr Surg,1988,82(5):815-832.DOI: 10.1097/00006534-198811000-00014.
    [8]
    IngvaldsenCA,TønsethKA,PrippAH,et al.Microcirculatory evaluation of the abdominal skin in breast reconstruction with deep inferior epigastric artery perforator flap[J].Plast Reconstr Surg Glob Open,2016,4(2):e616.DOI: 10.1097/GOX.0000000000000602.
    [9]
    HartrampfCR,ScheflanM,BlackPW.Breast reconstruction with a transverse abdominal island flap[J].Plast Reconstr Surg,1982,69(2):216-225.DOI: 10.1097/00006534-198202000-00006.
    [10]
    RozenWM, WhitakerIS, AshtonMW. A combined anatomical and clinical study for quantitative analysis of the microcirculation in the classic perfusion zones of the deep inferior epigastric artery perforator flap[J]. Plast Reconstr Surg,2011,128(3):821-822.DOI: 10.1097/PRS.0b013e3182221525.
    [11]
    BaileySH,Saint-CyrM,WongC,et al.The single dominant medial row perforator DIEP flap in breast reconstruction: three- dimensional perforasome and clinical results[J].Plast Reconstr Surg,2010,126(3):739-751.DOI: 10.1097/PRS.0b013e3181e5f844.
    [12]
    PatelNG,RamakrishnanV.Microsurgical tissue transfer in breast reconstruction[J].Clin Plast Surg,2020,47(4):595-609.DOI: 10.1016/j.cps.2020.06.010.
    [13]
    TeotiaSS,DickeyRM,LiuY,et al.Intraoperative microvascular complications in autologous breast reconstruction: the effects of resident training on microsurgical outcomes[J].J Reconstr Microsurg,2021,37(4):309-314.DOI: 10.1055/s-0040-1716404.
    [14]
    BhullarH,Hunter-SmithDJ,RozenWM.Fat necrosis after DIEP flap breast reconstruction: a review of perfusion-related causes[J].Aesthetic Plast Surg,2020,44(5):1454-1461.DOI: 10.1007/s00266-020-01784-1.
    [15]
    HallockGG.The complete nomenclature for combined perforator flaps[J].Plast Reconstr Surg,2011,127(4):1720-1729.DOI: 10.1097/PRS.0b013e31820a662b.
    [16]
    HallockGG.Branch-based conjoined perforator flaps[J].Plast Reconstr Surg,2008,121(5):1642-1649.DOI: 10.1097/PRS.0b013e31816aa022.
    [17]
    PenningtonDG,NettleWJ,LamP.Microvascular augmentation of the blood supply of the contralateral side of the free transverse rectus abdominis musculocutaneous flap[J].Ann Plast Surg,1993,31(2):123-126; discussion 126-127.DOI: 10.1097/00000637-199308000-00006.
    [18]
    宋达疆,李赞,周晓,等.股薄肌皮瓣联合大收肌穿支皮瓣在乳房重建中的应用[J].中国修复重建外科杂志,2018,32(6):707-713.DOI: 10.7507/1002-1892.201801001.
    [19]
    TugertimurB,DecW.Deep inferior epigastric artery perforator flap reconstruction for breast burn deformities[J].Plast Reconstr Surg Glob Open,2020,8(7):e2981.DOI: 10.1097/GOX.0000000000002981.
    [20]
    张世民,宋达疆.穿支皮瓣的发现发展历史与临床启示[J].中国修复重建外科杂志,2017,31(7):769-772.DOI: 10.7507/1002-1892.201701082.
    [21]
    HolmC,MayrM,HöfterE,et al.Perfusion zones of the DIEP flap revisited: a clinical study[J].Plast Reconstr Surg,2006,117(1):37-43.DOI: 10.1097/01.prs.0000185867.84172.c0.
    [22]
    BoerVB,van WingerdenJJ,WeverCF,et al.Perforator mapping practice for deep inferior epigastric artery perforator flap reconstructions: a survey of the benelux region[J].J Reconstr Microsurg,2021,37(2):111-118.DOI: 10.1055/s-0040-1714427.
    [23]
    WongC,Saint-CyrM,MojallalA,et al.Perforasomes of the DIEP flap: vascular anatomy of the lateral versus medial row perforators and clinical implications[J].Plast Reconstr Surg,2010,125(3):772-782.DOI: 10.1097/PRS.0b013e3181cb63e0.
    [24]
    HillbergNS,van MulkenT,Meesters-CabergM,et al.Autologous breast reconstruction with a delay procedure of the deep inferior epigastric artery perforator flap because of venous congestion of the flap on pedicle: a case series[J].Ann Plast Surg,2019,82(5):537-540.DOI: 10.1097/SAP.0000000000001752.
    [25]
    AgarwalJP,GottliebLJ.Double pedicle deep inferior epigastric perforator/muscle-sparing TRAM flaps for unilateral breast reconstruction[J].Ann Plast Surg,2007,58(4):359-363.DOI: 10.1097/01.sap.0000239818.28900.81.
    [26]
    CuiH,DingM,MaoY,et al.Three-dimensional visualization for extended deep inferior epigastric perforator flaps[J].Ann Plast Surg,2020,85(6):e48-e53.DOI: 10.1097/SAP.0000000000002379.
    [27]
    O'NeillAC, HaywardV, ZhongT, et al. Usability of the internal mammary recipient vessels in microvascular breast reconstruction[J]. J Plast Reconstr Aesthet Surg,2016 ,69(7):907-911. DOI: 10.1016/j.bjps.2016.01.030.
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