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Unlabelled: Bilateral prophylactic mastectomy without reconstruction is not accepted by the majority of patients. Successful reconstruction is therefore a mandatory condition for prophylactic mastectomy. Of the many options for autologous breast reconstruction, the deep inferior epigastric perforator (DIEP) flap best meets requirements for bilateral reconstruction in selected patients. The goal of this study is to verify the feasibility of the procedure in our conditions and to find out how it is accepted by patients. We present 55 consecutive patients who were scheduled for bilateral DIEP flap reconstruction during a 4-year period. We reviewed medical charts, performed clinical assessments and processed anonymous questionnaires. There were 77 immediate and 33 delayed breast reconstructions. There was 100% flap survival and no microanastomoses revisions. In 11 patients (10%) the surgeon preferred to convert the DIEP into a mini transverse rectus abdominis muscle (miniTRAM) flap in order to provide adequate blood supply., Complications: revision for haematoma under the flap in four patients (7.2%), excessive blood loss in four patients (7.2%) and partial mastectomy skin flap necrosis in 10 immediate breast reconstructions (12.9%). Patients' evaluation of the aesthetic result was good or excellent in 96.2% of cases. In 33.9% of patients the postoperative quality of life was considered unchanged and 50.9% of them it even improved. The DIEP flap is recommended for bilateral breast reconstruction. Occasional conversion into a miniTRAM flap can increase the total flap survival rate. Bilateral prophylactic mastectomy and DIEP flap reconstruction are very well accepted by patients. more...

One of the important microsurgical procedures in our department is breast reconstruction after ablations. For many years, the standard method was reconstruction with autologous tissues--a free TRAM flap with a recipient vessels vasa mammaria. We are convinced that this give very satisfactory results with microsurgical safety of operations. We use this method of reconstruction in 17-20 patients per year. The standard time of unilateral reconstruction is 2.5-4 hours, of bilateral reconstruction 4-6 hours. Postoperative morbidity in the abdominal region is, as a rule, associated with a weakening of the abdominal wall and the development of hemias (Galli et al., 1992); a perforator flap in which neither muscle nor fasciae are used creates the prerequisite condition for markedly reduced the morbidity associated with the site of flap collection. Although we used a perforator flap three times for reconstructions of the extremities as early as three years ago, we began to use it for breast reconstruction from the beginning of 2000. No doubt this late use of a large skin flap supplied by 1-2 perforators was due to a lack of trust in the provision of adequate blood perfusion for the large amount of tissue of the flap. From the beginning of 2000, in the course of five months, nine DIEP flaps were used for breast reconstructions, in two cases for bilateral reconstruction. In two instances sensory nerves of the flap were sutured to the branch of the intercostal nerves at the site of insertion. Seven flaps healed p.p.i; in two instances we were faced with the complication of postoperative venostasis, calling for revision and connection of the superficial venous system of the flap to the circulation. Subsequent healing was without complications. Preparation of the flap appears to be relatively easy, and the only pitfall is the selection of a suitable perforator. The operation is longer by half an hour than the classical free TRAM; when the sensory nerve of the flap is sutured, it is ca 1 hour longer. We like to use the DIEP flap for breast reconstruction, and it is a reliable method even for the reconstruction of large pendulous breasts. The donor site morbidity is significantly lower. more...

The treatment of serious tissue defects on the diabetic foot is complicated and tedious because of a combination of pathogenetic mechanisms that influence healing. Diabetic neuropathies (sensory, motor, vegetative), ischaemia and microangiopathies contribute in varying degrees to the adverse healing. The submitted three-year prospective study was focused on an analysis of the pathogenetic factors with the objective of defining the indications for one of three types of microsurgical transfer: 1. a free flap sutured directly to the vessels at the site of the defect (in predominantly neuropathic defects); 2. a free flap sutured to a politeopedal bypass (in predominantly ischaemic defects); 3. a "nourishing" flap sutured by means of a long venous graft to vessels of the medial and upper leg (in patients in whom an inadequate outflow tract does not make revascularisation possible). In the first year of the investigation, thirteen patients were operated on by means of a free muscle flap incl. three "nourishing" and ten sutured at the site of the defect. Twelve flaps were flaped healed; one patient died from myocardial infarction on the second day after surgery. more...

We have evaluated the donor site after harvesting the chinese flap in 40 patients operated at the Clinic of Plastic and Aesthetic Surgery of Brno between 1989 and 1994. We conclude that: 1--The hand function is not oustandly altered after harvesting the flap, but in our study 11 patients (27.5%) indicated that they have some limitation or impairment of their hand function. 2--Tolerance to forearm deformity is considerable, but it depends on degree of the defect for which the flap is transferred: 25 patients (62.5%) would like to elect a different flap. 3--It is necessary to think about cosmetic consequences of the chinese flap and consider other possibilities of the flap choice. Secondary defect may be for the patient a problem even several years after operation. more...

The author describes a method for covering skin defects of the scalp combining the principles of V-Y plasty and vascularization by means of the musculoaponeurotic layer. It is a simple operation, using the hairy skin in the vicinity of the defect with direct closure of the defect after transposition of the flap. With regard to the satisfactory cosmetic results, the method is suitable not only for primary defects after excision of tumours but also for medium-sized alopecias. more...

We present a single patient with a successful breast reconstruction using the peri-iliac fat pad as a free flap based on the deep circumflex iliac artery and vein. Although the follow-up is short, in this patient the donor site has been acceptable, and we believe that this flap will have a place in the selection of donor sites for autogenous tissue breast reconstruction. more...

The purpose of this article is to determine whether or not the transverse rectus abdominis musculocutaneous (TRAM) flap procedure is a practical operation for immediate breast reconstruction. Our series reports 128 consecutive patients who underwent immediate breast reconstruction with the TRAM flap from 1985 to 1990. Of these patients, 86 underwent conventional TRAM, while 40 underwent free TRAM breast reconstruction. Two-thirds of the patients underwent bilateral breast reconstruction. Comparison within this series of the free TRAM versus the conventional TRAM flap revealed improved statistics with regard to the free TRAM flap in a shorter hospitalization time and a decreased incidence of fat necrosis. There is no evidence to date that there is an increased chance of local recurrence with immediate breast reconstruction in this series, and chemotherapy was delayed in a single patient because of healing problems after immediate reconstruction. Operative times and the complication rate seem to be improving as compared with other series previously reported. The TRAM procedure, particularly the free TRAM procedure, is a primary choice for immediate breast reconstruction after mastectomy. more...

Venous congestion in the intraoperative and postoperative period can be a problem with some transverse rectus abdominis musculocutaneous flaps. We evolved a technique to allow us the ability to bleed the congested flap in a controlled manner both intra- and postoperatively. Arteriotomy cannulae are placed within the lumens of the deep inferior epigastric artery (DIEA) and vein (DIEV) and they are brought out on the lateral aspect of the reconstructed breast. We believe that intermittent venous bleeding from the DIEV allows a congested flap time to improve venous outflow and adapt to the new reversed blood circulation. When laser Doppler flow meter is simultaneously used as a monitor, bleeding from the DIEV or DIEA can improve balance between arterial and venous pressure in the flap. more...

We describe our experience and outcome with the ‘Proximal first dorsal metacarpal artery free flap’. Ten consecutive cases utilizing the proximal first dorsal metacarpal artery free flap for complex digital defects were studied. Surgical technique, patient demographics, and flap outcome data were collected. Patient satisfaction was analysed using a questionnaire. All defects healed successfully with no loss of free flaps. The short-pedicle proximal first dorsal metacarpal artery free flap enables primary closure of the donor site up to 2 cm of width (in nine of the ten donor sites). The flap is a reliable and versatile alternative in selected cases of complex digital injuries. [ABSTRACT FROM PUBLISHER] more...