Deep inferior epigastric perforator flap for breast reconstruction:experience with 43 flaps

Background In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous （TRAM） flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator （DIEP） free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap. Methods Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap （3 patients had bilateral procedures）, 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up. Results The mean age of the patients was 38.6 years （range, 28-50）. The size of the flaps was 11 cm×26 cm in average （height 10-12 cm, width 15-33 cm）. The mean length of the vascular pedicles was 9.3 cm （range, 7-12）. The patients were followed up for a mean of 16 months （range, 6-30 months）. During the follow-up, 2 （5%） patients had total flap loss, 2 （5%） had partial necrosis, 4 （9%） had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal. Conclusions The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce donor-site morbidity and provide an aesthetic refinement in breast reconstruction.

Reconstruction of complex chest wall defects:A case report

BACKGROUND Chronic radiative chest wall ulcers are common in patients undergoing radiation therapy.If not treated early,then symptoms such as erosion,bleeding and infection will appear on the skin.In severe cases,ulcers invade the ribs and pleura,presenting a mortality risk.Small ulcers can be repaired with pedicle flaps.Because radioactive ulcers often invade the thorax,surgeons need to remove large areas of skin and muscle,and sometimes ribs.Repairing large chest wall defects are a challenge for surgeons.CASE SUMMARY A 74-year-old female patient was admitted to our department with chest wall skin ulceration after radiation therapy for left breast cancer.The patient was diagnosed with chronic radioactive ulceration.After multidisciplinary discussion,the authors performed expansive resection of the chest wall ulcers and repaired large chest wall defects using a deep inferior epigastric perforator(DIEP)flap combined with a high-density polyethylene(HDPE)patch.The patient was followed-up 6 mo after the operation.No pigmentation or edema was found in the flap.CONCLUSION DIEP flap plus HDPE patch is one of the better treatments for radiation-induced chest wall ulcers.

A novel approach to achieve breast symmetry in a single-stage procedure

Preservation of the skin envelope and the inframammary fold is the main factor in achieving breast symmetry in unilateral reconstruction.Skin sparing mastectomy(SSM)type-IV followed by immediate autologous reconstruction and contralateral symmetrization permits realizing this goal in large,ptotic breasted patients,and tumor superficially located in the inferior quadrants.If the tumor is superficially located in the superior or inferior quadrants with a previous lumpectomy or quadrantectomy scar in the superior quadrants,modified radical mastectomy and a staged procedure are recommended to avoid poor cosmetic results.Two patients who underwent immediate autologous reconstruction following SSM type-V with contralateral symmetrization in a one-stage procedure are presented.