BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-...BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.展开更多
BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irrever...BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.展开更多
Breast reconstruction surgery means using autologous tissue grafts and breast prosthesis to rebuild chest wall deformities and the absence of breast caused by post mastectomy,which are possibly due to burns,trauma,inf...Breast reconstruction surgery means using autologous tissue grafts and breast prosthesis to rebuild chest wall deformities and the absence of breast caused by post mastectomy,which are possibly due to burns,trauma,infections,congenital dysplasia and sex reassignment surgery etc.,with the prevalence of unilateral breast reconstruction.After attempting to carry out breast reconstruction with latissimus dorsi,many surgeons constantly improved,designed,and modified multiple forms of operation programs and thus promote increasing improvement in repair and reconstruction of the breast after breast reduction surgery and mastectomy for breast cancer[1].Currently,breast reconstruction after breast cancer surgery is just in the early stage while it has occupied an important position in developed countries,therefore,the knowledge of breast reconstruction needs to be enhanced and publicized in our country.Some data show the quality of life in patients following breast reconstruction surgery is significantly higher than that in patients undergoing lumpectomy plus radiotherapy or simple mastectomy.More and more patients pursue breast reconstruction after mastectomy for breast cancer.Breast reconstruction is roughly divided into lost chest wall skin repair,hemispherical breast reconstruction,anterior axillary fold repair,plastic surgery for subclavian depression,nipple and areola reconstruction and asymmetrical breast repair.In the reconstruction of breasts,it is necessary to endeavor to make the rebuilt breast symmetrical to the healthy side so that future adjustment will be simple and easily feasible.展开更多
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...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.展开更多
Autologous breast reconstruction with perforators has been previously avoided in tissues that have undergone liposuction.We present a case series and literature review of breast reconstruction with deep inferior epiga...Autologous breast reconstruction with perforators has been previously avoided in tissues that have undergone liposuction.We present a case series and literature review of breast reconstruction with deep inferior epigastric perforator(DIEP)flaps after abdominal wall liposuction.An MEDLINE search was performed for all relevant articles describing breast reconstruction with DIEP flap technique following the abdominal wall liposuction.Key search words used included“DIEP”,“DIEAP”,“deep inferior epigastric perforator”,“liposuction”and“free flap”.All published data on the topic from 1965 to December 2014 were reviewed.Articles were assessed for reports of clinical cases,complications,age,liposuction amount,time since liposuction and number of perforators for comparison.We have also presented 2 patients who underwent a DIEP procedure with a previous history of liposuction.Eight cases of autologous breast reconstruction using a DIEP flap after liposuction were identified in the literature in addition to the presented cases.The preoperative and postoperative course was uneventful in all cases except one patient who had a mild cellulitis managed with antibiotics and a second patient with a drainable hematoma.The average age was 52 years±6.4 years old,one perforator was used in all cases except one where 2 were used,and the average amount of total liposuction was 1,084 mL.No major complications were reported.Previous liposuction is not an absolute contraindication for free-flap breast reconstruction.Preoperative management should include evaluation of suitable perforators by duplex ultrasound or computed tomography angiography.Larger case series are needed to better understand the safety of perforator flaps after liposuction.展开更多
Aim:Autologous tissue is considered the“gold standard”for breast reconstruction today.However,little is known about deep inferior epigastric perforator(DIEP)flap reconstruction in combination with tissue expander(TE...Aim:Autologous tissue is considered the“gold standard”for breast reconstruction today.However,little is known about deep inferior epigastric perforator(DIEP)flap reconstruction in combination with tissue expander(TE)/implant.The authors describe a series of combined DIEP flap/TE reconstruction,including its indications and technique to ensure protection of the pedicle during the expansion process.Methods:Between January 2009 and December 2012,patients undergoing immediate DIEP with TE reconstruction were retrospectively reviewed.Oncologic,comorbid conditions,intraoperative,postoperative expansion,complications,and technique data points were collected.Photographs were taken postoperatively and patient’s satisfaction surveys were obtained to assess overall satisfaction.Results:Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm sling technique.There were no complications to the pedicle,flap,expander,or mastectomy skin perioperatively or postoperatively.All patients describe being very satisfied,often with improved breast volume and projection as compared to their preoperative appearance.Conclusion:The results of this study suggest that DIEP flap/TE reconstruction is safe,in particular when utilizing the alloderm sling technique,and should be considered in patients who lack sufficient abdominal tissue,have existing breast asymmetries,or do not desire the scar deformity of latissimus dorsi.展开更多
基金Supported by The Bio&Medical Technology Development Program of the National Research Foundation(NRF)funded by the Korean government(MSIT),No.RS-2023-00220408.
文摘BACKGROUND Pedicled abdominal flaps are a widely used surgical technique for forearm reconstruction in patients with soft tissue defects.However,some drawbacks include restricted flap size,partial flap loss,and donor-site morbidity.To address these concerns,we present a case of a pedicled abdominal flap using the deep inferior epigastric artery perforators(DIEP)for forearm reconstruction in a patient with a large soft tissue defect.CASE SUMMARY A 46-year-old male patient was admitted to our hospital with forearm injury caused by a pressing machine.A 15 cm×10 cm soft tissue defect with complete rupture of the ulnar side structures of the forearm was found.One week after orthopedic management of the neurovascular injury and fractures using the first stage of Masquelet technique,the patient was referred to the plastic and recon-structive surgery department for wound coverage.Surgical debridement and negative-pressure wound therapy revealed a 20 cm×15 cm soft tissue defect.A pedicle abdominal flap with the DIEP was used to cover the defect.Three weeks later,the flap was detached from the abdomen,and the abdominal defect was directly closed.Subsequently,the second stage of Masquelet technique was performed at the fracture site at week 10.Finally,all donor and recipient sites healed without complications,such as flap dehiscence,infection,hematoma,or necrosis.Fracture site osteosynthesis was achieved without complications.CONCLUSION Pedicled abdominal flap using the DIEP provides a reliable option for forearm reconstruction in patients with large soft tissue defects.
文摘BACKGROUND Thermal injuries on free transferred or replanted tissues resulting from loss of sensibility are an infrequent occurrence.They require immediate and appropriate management before they progress to an irreversible condition.Although negative pressure wound therapy(NPWT)can prevent wound progression by increasing microcirculation,the inappropriate application of NPWT on complicationthreatened transferred and replanted tissues can induce an adverse effect.CASE SUMMARY A 48-year-old woman who underwent immediate breast reconstruction with a deep inferior epigastric artery perforator free flap.While applying a heating pad directly to the flap site,she sustained a deep second to third-degree contact burn over 30%of the transferred flap on postoperative 7 d.As the necrotic changes had progressed,we applied an NPWT dressing over the burned area after en-bloc debridement of the transferred tissues on postoperative 21 d.After 4 d of NPWT application,the exposed fatty tissues of the flap changed to dry and browncolored necrotic tissues.Upon further debridement,we noted that the wound gradually reached total necrosis with a collapsed vascular pedicle of deep inferior epigastric artery.CONCLUSION Although NPWT has been shown to be successful for treating various wound types,the significant risk of NPWT application in short-lasting reconstructed flap wounds after thermal injury should be reminded.
文摘Breast reconstruction surgery means using autologous tissue grafts and breast prosthesis to rebuild chest wall deformities and the absence of breast caused by post mastectomy,which are possibly due to burns,trauma,infections,congenital dysplasia and sex reassignment surgery etc.,with the prevalence of unilateral breast reconstruction.After attempting to carry out breast reconstruction with latissimus dorsi,many surgeons constantly improved,designed,and modified multiple forms of operation programs and thus promote increasing improvement in repair and reconstruction of the breast after breast reduction surgery and mastectomy for breast cancer[1].Currently,breast reconstruction after breast cancer surgery is just in the early stage while it has occupied an important position in developed countries,therefore,the knowledge of breast reconstruction needs to be enhanced and publicized in our country.Some data show the quality of life in patients following breast reconstruction surgery is significantly higher than that in patients undergoing lumpectomy plus radiotherapy or simple mastectomy.More and more patients pursue breast reconstruction after mastectomy for breast cancer.Breast reconstruction is roughly divided into lost chest wall skin repair,hemispherical breast reconstruction,anterior axillary fold repair,plastic surgery for subclavian depression,nipple and areola reconstruction and asymmetrical breast repair.In the reconstruction of breasts,it is necessary to endeavor to make the rebuilt breast symmetrical to the healthy side so that future adjustment will be simple and easily feasible.
文摘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.
文摘Autologous breast reconstruction with perforators has been previously avoided in tissues that have undergone liposuction.We present a case series and literature review of breast reconstruction with deep inferior epigastric perforator(DIEP)flaps after abdominal wall liposuction.An MEDLINE search was performed for all relevant articles describing breast reconstruction with DIEP flap technique following the abdominal wall liposuction.Key search words used included“DIEP”,“DIEAP”,“deep inferior epigastric perforator”,“liposuction”and“free flap”.All published data on the topic from 1965 to December 2014 were reviewed.Articles were assessed for reports of clinical cases,complications,age,liposuction amount,time since liposuction and number of perforators for comparison.We have also presented 2 patients who underwent a DIEP procedure with a previous history of liposuction.Eight cases of autologous breast reconstruction using a DIEP flap after liposuction were identified in the literature in addition to the presented cases.The preoperative and postoperative course was uneventful in all cases except one patient who had a mild cellulitis managed with antibiotics and a second patient with a drainable hematoma.The average age was 52 years±6.4 years old,one perforator was used in all cases except one where 2 were used,and the average amount of total liposuction was 1,084 mL.No major complications were reported.Previous liposuction is not an absolute contraindication for free-flap breast reconstruction.Preoperative management should include evaluation of suitable perforators by duplex ultrasound or computed tomography angiography.Larger case series are needed to better understand the safety of perforator flaps after liposuction.
文摘Aim:Autologous tissue is considered the“gold standard”for breast reconstruction today.However,little is known about deep inferior epigastric perforator(DIEP)flap reconstruction in combination with tissue expander(TE)/implant.The authors describe a series of combined DIEP flap/TE reconstruction,including its indications and technique to ensure protection of the pedicle during the expansion process.Methods:Between January 2009 and December 2012,patients undergoing immediate DIEP with TE reconstruction were retrospectively reviewed.Oncologic,comorbid conditions,intraoperative,postoperative expansion,complications,and technique data points were collected.Photographs were taken postoperatively and patient’s satisfaction surveys were obtained to assess overall satisfaction.Results:Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm sling technique.There were no complications to the pedicle,flap,expander,or mastectomy skin perioperatively or postoperatively.All patients describe being very satisfied,often with improved breast volume and projection as compared to their preoperative appearance.Conclusion:The results of this study suggest that DIEP flap/TE reconstruction is safe,in particular when utilizing the alloderm sling technique,and should be considered in patients who lack sufficient abdominal tissue,have existing breast asymmetries,or do not desire the scar deformity of latissimus dorsi.
