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Background: There is an increasing evidence for the use of thin flaps based on vascular perforators for reconstructive surgeries. The medial sural and deep inferior epigastric artery flaps offer versatility for the reconstruction of major defects of the head and neck. Objectives: “Whether medial sural artery perforator (MSAP) flap or rectus abdominis perforator flap is better for the reconstruction of glossectomy defects in terms of functional outcome?” Data Sources: PubMed, Cochrane Library, clinicaltrials.gov and hand searches. Participants and Interventions: Patients who underwent tongue reconstruction with either MSAP flap or deep inferior epigastric artery perforator (DIEAP) flap. Study Appraisal and Synthesis Methods: Based on defined study criteria 6 studies were selected according to Prisma Guidelines. The overall estimated effect was categorized as significant where P < 0.05. Results: There was no significant difference between both flaps in terms of receptor site complications (P = 0.223). Overall odds ratio (OR) for complications was 1.35 (95% confidence interval [CI]: 0.412–0.736) and the test for overall effect t value was 2.836, P < 0.05. Overall OR was 6.01 (95% CI 0.5–7.45) and the test for overall effect t value was 1.41, P < 0.05 indicating there was a statistical difference in the intelligibility of speech. Limitations: Anatomical variations, under-reporting of studies and lack of universal tool for speech intelligibility. Conclusions and Implications of Key Findings: Both the flaps are comparable in terms of functional outcome. Medium-sized defects can be reconstructed with MSAP and composite larger defects would benefit from DIEAP. In females, anterolateral thigh flap still remains the choice for composite reconstructions.

Item does not contain fulltext BACKGROUND: During a deep inferior epigastric perforator (DIEP) flap harvest, the identification and localization of the epigastric arteries and its perforators are crucial. Holographic augmented reality is an innovative technique that can be used to visualize this patient-specific anatomy extracted from a computed tomographic scan directly on the patient. This study describes an innovative workflow to achieve this. METHODS: A software application for the Microsoft HoloLens was developed to visualize the anatomy as a hologram. By using abdominal nevi as natural landmarks, the anatomy hologram is registered to the patient. To ensure that the anatomy hologram remains correctly positioned when the patient or the user moves, real-time patient tracking is obtained with a quick response marker attached to the patient. RESULTS: Holographic augmented reality can be used to visualize the epigastric arteries and its perforators in preparation for a deep inferior epigastric perforator flap harvest. CONCLUSIONS: Potentially, this workflow can be used visualize the vessels intraoperatively. Furthermore, this workflow is intuitive to use and could be applied for other flaps or other types of surgery.

Обстежено та проліковано 233 хворих із трофічними виразками нижніх кінцівок (ХТВ): 137 хворих із венозними (С6, Ep/Es, Pr 2, 3, 4, 18), 96 на хронічну критичну ішемію нижніх кінцівок ІІІ ст. (КІНК), зумовлену периферичною формою атеросклерозу судин. У першу і другу групу контролю ввійшли хворі, яким проведене комплексне лікування за загальноприйнятими схемами. У третю і четверту групу ввійшли хворі, яким використано ізольовану автодермопластику вільними перфорованими клаптями шкіри (АВПКШ). У п’ятій групі з венозними ХТВ виконано радикальний венекзерез. У шостій групі проведена катетеризація нижньої надчеревної артерії (КННА) з наступною доартеріальною інфузією медикаментозних середників, остеоперфорація великогомілкової кістки (ОПВГК).Ключові слова: хронічні трофічні виразки нижніх кінцівок, хронічна венозна недостатність, облітеруючий атеросклероз, критична ішемія нижніх кінцівок, катетеризація нижньої надчеревної артерії, остеоперфорація великогомілкової кістки.

Background and aims. The aim of this study is to find the most suitable protocol based on an animal experimental model, through the use of a fluorescent dye, determining also its minimal concentration needed to stain the skin after arterial injection, in order to be evidence the functional perforasome by visual examination. Methods. Methylene blue solution was used in order to determine the territory vascularized by one perforator on fresh cadavers in many studies which introduced, as a final result, the concept of perforasome. One of the most frequent complications of perforator flaps is partial flap necrosis which could be avoided by correctly assessing pre-operatively the functional perforasome surface. Two groups of seven rats were used in order to establish a proper surgical protocol to evaluate the functional perforasome in vivo by injecting the dye. Also, the minimal concentration for methylene blue was experimentally determined. Results. The direct injection into the femoral artery of the proper concentration of dye, 1mM for methylene blue and the clamping of all the branches except the medial branch of the superficial epigastric artery is a reliable model to study the functional perforasome. Conclusions. Our study demonstrates that the intraoperative assessment with fluorescent dye of the functional perforasome by intra-arterial injection of methylene blue is an easy, affordable and very efficient method to reduce the number of partial necrosis of the perforator flaps.

The internal thoracic artery (ITA) arises from the subclavian artery and terminates as the musculophrenic and inferior epigastric arteries. During routine cadaveric dissection, an aberrant left ITA was discovered. A medial and a lateral branch of the ITA branched directly off the subclavian artery as opposed to bifurcating at the 6th or 7th intercostal space. To our knowledge, this is the first reported case of this particular ITA variation arising from the third part of the subclavian artery. Additionally, such a variant might also be considered a high bifurcation of the ITA. Our report examines this variation and its potential implications for coronary artery bypass grafts where the ITA is commonly used.

Flap surgery is frequently used in plastic surgery to close tissue defects. Ischemia-reperfusion (I/R) injury is a significant problem resulting in partial or total flap necrosis. This study aimed to investigate the effect of ceruloplasmin on I/R injury in epigastric island flaps in rats.A total of 32 male Sprague-Dawley rats were divided into four groups with eight rats in each group: The flap was not elevated in Group I; the flap was elevated without ischemia or any application in Group II, after the intraperitoneal saline and ceruloplasmin application the flaps were elevated and ischemia was created in group III-IV, respectively. Bilateral epigastric artery flap was elevated in all groups except Group I. After 6 h of ischemia, the flap was reperfused and inset. Samples were taken from the right and left side of the flap area in other groups at the postoperative 24th h for biochemical analysis (catalase and malondialdehyde-MDA) and the seventh postoperative day for histopathological analysis (Modified Verhofstad score and epidermal thicknesses), respectively. Image analysis for necrosis areas was performed on photos taken on the 7th d.Catalase level was significantly higher in Group IV.(0.15 ± 0.04 U/mg protein) (P0.05) Necrosis area percentage(14.4% ± 3.3%),MDA(3.6 ± 0.9 nmol/mg protein), edema(3), necrosis(2.75), and polymorphonuclear leukocyte infiltration(2.87) scores were significantly higher in group III.(P0.05). Fibroblast proliferation, collagen density (0.25), vascular density (0.25) scores and epidermal thickness (15.68 µm,) was significantly lower in group III. (P0.05) CONCLUSIONS: Our study demonstrated that ceruloplasmin application before ischemia reduced I/R injury in epigastric island flaps in rats.

Despite flap disadvantages (abdominal wall weakness, flap bulk, need to reconstruct rectus sheath), nowadays, vertical rectus abdominis musculocutaneous (VRAM) and transverse rectus abdominis musculocutaneous (TRAM) flaps are widely used in various modifications (longitudinal, transverse, oblique design) both as pedicled and free flaps. The VRAM flap is based on the rectus abdominis muscle, which attaches to the xiphoid process of the cartilaginous part of the sixth to eighth ribs and inserts at the pubic bone. Rectus abdominis muscle is an axillar flap and gets its main vascular supply from deep epigastric vessels.

Author(s): Sulkowski, Kathryn; Young, Christian | Abstract: Introduction: Spontaneous rupture of an inferior epigastric artery aneurysm is rare with very few cases reported in the medical literature. Although surgical options are available, this case was managed conservatively with outpatient management.Case Report: A 29-year-old male presented with right groin pain and swelling that was initially felt to be consistent with an incarcerated inguinal hernia. Further evaluation revealed spontaneous rupture of an inferior epigastric artery aneurysm. The patient was treated conservatively and was ultimately discharged home from the emergency department.Conclusion: Due to the similar clinical presentations, it was important to consider a broad differential to ultimately arrive at the correct diagnosis. In some reported cases of spontaneous epigastric artery aneurysm, surgical intervention was required for control of the bleeding. In our patient, however, conservative management was employed, and the patient was able to be safely discharged with close outpatient follow-up.

Formation of peritoneal adhesions is the most frequent complication of abdominal and pelvic surgery and comprises a lifelong risk of adhesion-related morbidity and mortality. Some of the existing antiadhesive barriers are less effective in the presence of blood. In this study, we investigate the efficacy and safety of ultrapure alginate gel in the presence of blood.In experiment 1 (30 rats), 1 mL ultrapure alginate gel was compared with no intervention in a model of cecal abrasion and persisting peritoneal bleeding by incision of the epigastric artery. In experiment 2 (30 rats), 2 mL ultrapure alginate gel was compared with no intervention in a model where a 1 mL blood clot was instilled intra-abdominally and a cecal resection was performed. The primary endpoint was the incidence and severity of adhesions after 14 d.In experiment 1, seven of 15 rats in the experimental group had intra-abdominal adhesions compared with 13 of 15 rats in the control group (P = 0.05); 3 of 15 rats had adhesions at the site of injury compared with 12 of 15 rats in the control group (P 0.01). The severity and extent of adhesions was also reduced (P 0.01). In experiment 2, 12 of 13 rats had adhesions compared with 13 of 14 rats in the control group (P = 1.00).Ultrapure alginate gel reduces the incidence and severity of adhesion in the presence of persisting bleeding, but not in a model of cecal resection and blood clot.

Objective To determine the location of the deep and superficial caudal epigastric arteries in relation to 3 midline positions and the relationship between the location of these arteries, body circumference, and body condition score. Study design Descriptive anatomical study. Sample population Nine horses, aged 1-28 years (mean 10.61 ± 8.89 SD). Methods Body condition score and body circumference were measured prior to euthanasia. Angiographic studies of the deep and superficial caudal epigastric arteries were performed on resected abdominal walls. The distances between the deep and the superficial caudal epigastric arteries and 3 midline positions were measured. Correlations among these distances, body circumference, and body condition score were analyzed. Results The location of the deep caudal epigastric artery correlated with body circumference and body condition score at the umbilicus (r = 0.53 and 0.68, respectively), midpoint landmark (r = 0.79 and 0.83, respectively), and prepubic tendon attachment (r = 0.69 and 0.78, respectively). The course of this artery could be estimated by multiplying body circumference by 0.04 ± 0.02 at the umbilicus, 0.07 ± 0.01 at the midpoint landmark, and 0.03 ± 0.015 at the prepubic tendon attachment. The course of the superficial caudal epigastric artery did not correlate with anatomic landmarks. Conclusion The course of the deep caudal epigastric artery could be estimated at 3 midline landmarks on the basis of body circumference and body condition score in equine cadavers. Clinical significance Predicting the course of the caudal epigastric arteries in the equine abdomen based on correlation among location, body circumference, and body condition score may prevent iatrogenic damage during creation of laparoscopic portals.

Objective: Injury of the vessels of the anterior abdominal wall occurs in 0.2%–2% of laparoscopic surgeries, most commonly in the inferior epigastric artery (IEA). The objective of this st...

The review of national and foreign literature sources presents information on arterial blood supply of the umbilical region in newborns having relevant practical significance due to the development of new surgical approaches in that part of the anterior abdominal wall. Scientific data on the course and location of arteries participating in the blood supply of the umbilical region are summarized. Particular attention is devoted to the description of superficial, superior and inferior epigastric arteries and umbilical arteries. The issues of intervascular connections between the named arteries and other blood vessels are discussed including information on various anastomosis variations and their extent. Various existing viewpoints regarding the location and depth of anastomoses between the vessels essential for blood supply of the umbilical region are presented as well as the layers, through which the main arteries pass, and the character and level of their branching. Features of arterial blood supply of the umbilical region in newborns are also noted. The paper contains data on the role of umbilical arteries in the umbilical region supply in children of that age. It is demonstrated that blood supply of the umbilical region in newborns still poses issues that are insufficiently researched and solved, such as assessing functional capacity of the umbilical arteries, revealing histotopographic peculiarities in the location of blood vessels within the layers and various segments of the umbilical region, topographic and anatomic identification of the segments that are most and least supplied with arterial vessels in that part of the abdominal wall.

The aim of this study was to demonstrate the feasibility of in vivo perforator visualization by a newly proposed magnetic resonance-based perforator phase contrast angiography (pPCA) technique for deep inferior epigastric perforator (DIEP) flap surgery and to prospectively compare its image quality and clinical value with computed tomographic angiography (CTA), the state-of-the-art perforator imaging technique.Institutional review board approval and informed consent were obtained. DIEP pPCA and CTA data were acquired in 10 female patients before DIEP flap surgery. Image findings were compared between the two techniques and with literature reports.The overall image quality is negatively correlated with patient BMI for CTA, but positively correlated with BMI for pPCA. Compared with CTA, pPCA has significantly better image quality (P = 0.005), signal-to-noise ratio (P0.001), and contrast-to-noise ratio (perforator-to-muscle, P0.001; perforator-to-fat, P = 0.014). It also has preferable clinical value ratings, although not statistically significant (P = 0.388). There is a good agreement (84%) between perforators detected by pPCA and CTA. Perforator location deviations between pPCA and CTA are compatible with the precision required for plastic surgery. Perforator size measured by pPCA seems to be more accurate than CTA, as it is 0.8 ± 0.3 mm smaller (P0.001), consistent with the reported 0.5 to 1.2 mm overestimation by CTA. There is no significant difference in perforator intramuscular course assessment (P = 0.415).The developed magnetic resonance-based pPCA technique presents superior image quality, better vessel contrast, and more accurate perforator anatomy than the x-ray-based CTA. pPCA has the potential to emerge as the preferred preoperative planning tool for perforator flap reconstructive surgery.

A Pfannenstiel incision involves the obstruction of superficial venous pathways and functional diversion of flow through alternative pathways and adjacent vessels. This study investigated the effect of a prior Pfannenstiel incision on venous anatomy of the lower abdominal wall; specifically, the superficial inferior epigastric vein (SIEV), using computed tomographic angiography.A case-control study was performed of 50 patients with Pfannenstiel scars and 50 age-matched, body mass index-matched control patients without Pfannenstiel scars. The authors compared the number of direct/indirect and total communications between the SIEV and deep inferior epigastric artery perforator (DIEP) venae comitantes, midline crossover, and other SIEV-related anatomical changes by using computed tomographic angiography. Flap-related clinical outcomes and donor-site-related complications were also assessed.The median number of direct and total communications between the SIEV and DIEP venae comitantes in the study group was greater than in the control group. The percentage of SIEVs having more than two branching patterns per hemiabdomen was significantly higher in the study group than in the control group. The study group also showed a significantly lower rate of fat necrosis compared with the control group (p = 0.03). The rate of donor-site seroma was significantly higher in the study group.This study suggests that the presence of a Pfannenstiel scar may promote the development of direct and total communications between the SIEV and DIEP venae comitantes and branching within the SIEV in the lower abdominal wall, which may facilitate venous drainage of adipose tissue in DIEP flap breast reconstruction.Risk, II.

Pseudoaneurysm occurs when the artery wall is damaged and the blood is contained by the surrounding tissues with the eventual formation of a fibrous sac communicating with the artery. We report a case of a 74-year-old man with inferior epigastric artery (IEA) pseudoaneurysm secondary to an 8-mm port placement during a robot-assisted laparoscopic radical cystectomy with ureteroileocutaneostomy. The pseudoaneurysm was initially diagnosed by contrast-enhanced ultrasound (CEUS); subsequently, a computed tomography (CT) scan and an angiography test were performed. The pseudoaneurysm was then treated successfully with embolization of the inferior epigastric artery. Awareness of this rare complication is of clinical importance to avoid excessive morbidity of affected individuals.

Objectives. This is a descriptive study to determine the origin of abnormal obturator arteries, the drainage of abnormal obturator veins, and if any anastomoses exist between these abnormal vessels in Filipino cadavers. Methods. A total of 54 cadaver halves, 50 dissected by UP medical students and 4 by UP Dentistry students were included in this survey. Results. Results showed the abnormal obturator arteries arising from the inferior epigastric arteries in 7 halves (12.96%) and the abnormal communicating veins draining into the inferior epigastric or external iliac veins in 16 (29.62%). There were also arterial anastomoses in 5 (9.25%) with the inferior epigastric artery, and venous anastomoses in 16 (29.62%) with the inferior epigastric or external iliac veins. Bilateral abnormalities were noted in a total 6 cadavers, 3 with both arterial and venous, and the remaining 3 with only venous anastomoses. Conclusion. It is important to be aware of the presence of these abnormalities that if found during surgery, must first be ligated to avoid intraoperative bleeding complications.

Background Patients with chronic kidney disease stage 5 (CKD5) are predisposed to vascular calcification (VC), but the combined effect of factors associated with VC was sparsely investigated. We applied the relaxed linear separability (RLS) feature selection model to identify features that concomitantly associate with VC in CKD5 patients. Methods Epigastric arteries collected during surgery from living donor kidney transplant recipients were examined to score the histological extent of medial VC. Sixty-two phenotypic features in 152 patients were entered into RLS model to differentiate between no-minimal VC (n = 93; score 0-1) and moderate-extensive VC (n = 59; score 2-3). The subset of features associated with VC was selected on the basis of cross-validation procedure. The strength of association of the selected features with VC was expressed by the absolute value of 'RLS factor'. Results Among 62 features, a subset of 17 features provided optimal prediction of VC with 89% of patients correctly classified into their groups. The 17 features included traditional risk factors (diabetes, age, cholesterol, BMI and male sex) and markers of bone metabolism, endothelial function, metabolites, serum antibodies and mitochondrial-derived peptide. Positive RLS factors range from 1.26 to 4.05 indicating features associated with increased risk of VC, and negative RLS factors range from -0.95 to -1.83 indicating features associated with reduced risk of VC. Conclusion The RLS model identified 17 features including novel biomarkers and traditional risk factors that together concomitantly associated with medial VC. These results may inform further investigations of factors promoting VC in CKD5 patients.

Objectives. Bone ischemia and necrosis are challenging to treat, requiring investigation of native and engineered bone revascularisation processes through advanced imaging techniques. This study demonstrates an experimental two-step method for precise bone and vessel analysis in native bones or vascularised bone grafts using X-ray microtomography (μCT), without interfering with further histological processing. Methods. Distally ligated epigastric arteries or veins of 6 nude rats were inserted in central channels of porous hydroxyapatite cylinders and these pedicled grafts were implanted subcutaneously. One week later, the rats were perfused with ink-gelatin and euthanised and the femurs, tibias, and grafts were explanted. Samples were scanned using μCT, decalcified, incubated with phosphotungstic acid (PTA) for contrast enhancement, rescanned, and processed histologically. Results. Contrast-enhanced μCT displayed the course and branching of native bone vessels. Histologically, both central (−17%) and epiphyseal vessels (−58%) appeared smaller than in μCT scans. Hydroxyapatite cylinders were thoroughly vascularised but did not display bone formation. Grafts with a central artery had more (+58%) and smaller (−52%) vessel branches compared to grafts with a vein. Conclusions. We present a relatively inexpensive and easy-to-perform two-step method to analyse bone and vessels by μCT, suitable to assess a variety of bone-regenerative strategies.

Renal biopsy is often needed to diagnose posttransplant graft dysfunction. Although it is very safe due to availability of real-time imaging, complications do occur. We report a rare case of anterior abdominal wall vessel injury during allograft biopsy resulting in a large perigraft hematoma. It mimics a subcapsular hematoma due to intrarenal vessel injury leading to diagnostic confusion. We detected a partially thrombosed pseudoaneurysm 3 weeks after the biopsy which had feeders from superior and inferior epigastric artery confirmed by injecting contrast into the pseudoaneurysm. The pseudoaneurysm is due to injury to small branch of these arteries. We used a novel and a cost-effective therapeutic intervention to treat this pseudoaneurysm. We injected thrombin percutaneously into pseudoaneurysm which enables thrombosis of the feeder vessels preventing recurrence.

Small saccular aneurysm in the right gastroepiploic artery is a sporadic disease accounting for approximately 0.4% of abdominal visceral aneurysms rarely observed during routine examination of other illnesses; however, it has been reported following rupture. The right gastroepiploic artery is a common alternative to the internal thoracic artery in coronary artery bypass grafting. We report a case of small aneurysms in the left anterior descending artery, diagonal branch artery, and right gastroepiploic artery and a pseudoaneurysm in right gastroepiploic artery. Coronary artery bypass grafting was performed using the left internal thoracic artery and right gastroepiploic artery, and a 5-mm aneurysm was observed in the right gastroepiploic artery. The resected 5-mm right gastroepiploic artery aneurysm was saccular. Pathological investigation revealed media loss and adventitial thinning, indicating the possibility of an aneurysm rupture. Thus, preoperative three-dimensional computed tomography is beneficial for patients with coronary arterial aneurysms and preoperative evaluation of right gastroepiploic artery to help achieve good clinical outcomes in patients undergoing coronary artery bypass grafting with another arterial aneurysm.

We report a case of cardiac catheterization that was done entirely by accidentally accessing the inferior epigastric artery (IEA) through an unintentional puncture of the U-shaped portion of the inferior epigastric artery. Luckily the patient did not have any trauma to the IEA and was d/c home with no complications. A 48-year-old female with history of hypertension and CAD S/P left circumflex stent many years ago who presented to our facility with persistent crescendo angina for which decision was made to proceed with LHC. The cardiac catheterization showed no significant CAD with patent stent so it was decided that there is no further intervention needed. Femoral angiogram was done and showed that the stick was high and the tip of the sheath was about to come out of the CFA; at the same time, it came into our minds that the sheath could be passing through the IEA by sticking the U portion of the IEA, but due to the high risk, an immediate access was obtained through the contralateral groin then a balloon over the wire was passed beyond the original sheath tip, then the sheath was slowly pulled back while contrast was injected. Angiogram showed that the sheath was inserted through the U-shaped portion of the IEA. Conclusion. Ultrasound guidance should be the first-line standard for arterial access in any cardiac catheterization procedure. US is a proven tool that can increase success and decrease complications in a wide variety of vascular access procedures.

Purpose Perfusion zones of the deep inferior epigastric perforator (DIEP) flap aid surgeons in estimating approximate tissue territory with reliable perfusion. Since the Hartrampf perfusion zone was developed, it has been modified continuously; however controversies remain regarding whether the recent perfusion models can satisfy current anatomical and clinical evidence. We conducted a comprehensive review of previous studies to synthesize relevant knowledge and critically reappraise current perfusion models. Methods All anatomical and clinical studies that investigated perfusion of DIEP flaps were searched, yielding 21 studies suitable for review. A meta-analysis was conducted when sufficient data were provided. Results The perforators had unpredictable subcutaneous courses and were preferentially directed laterally. The medial and lateral perforators showed different characteristics in terms of branching pattern, orientation, and linking vessels between them. Ex-vivo perfusion findings suggested that medial perforators favored Hartrampf zone II rather than zone III and perfused the entire abdomen frequently, whereas the lateral perforators favored zone III and their perfusion territories were limited primarily to the hemi-abdomen. In the meta-analysis based on the clinical perfusion studies, zone III had significantly higher perfusion than zone II (P = 0.04) and these tendencies remained in both medial and lateral perforator-based flaps. Conclusions Considerable discrepancies were found between findings of ex-vivo and clinical perfusion studies. A thorough review of existing knowledge based on the perforasome concept explained these discrepancies satisfactorily and revealed unsolved issues of the current perfusion models. Flap perfusion clearly varies widely individually; however, this review will help with surgical planning and decision making. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:98-108, 2018.

Nowadays, microvascular breast reconstruction with abdominal perforator flap is a popular and widespread technique. However, venous congestion is a recurrent problem in deep inferior epigastric artery perforator (DIEP) flap survival. We present a venous supercharging technique using the thoracoacromial vein in DIEP free flap for breast reconstruction.A prospective randomized study was conducted in 52 patients undergoing a free DIEP flap breast reconstruction. Classical DIEP flap using 1 venous anastomosis (DIEP group) was compared with thoracoacromial venous supercharged DIEP flap using the ipsilateral superficial epigastric vein as a supercharging vein (DIEP-TAsc group). The endpoint was to assess the equivalence or the superiority of each technique. Statistical analysis was made with the t test and the χ test.Venous congestion occurred in 16 (55.1%) patients in the DIEP group, and 3 (13%) patients in the DIEP-TAsc group (P = 0.001). The venous congestion rate was 36.5%. Fat necrosis was experienced by 14 (48.2%) patients in the DIEP group, and 4 (17.4%) patients in the DIEP-TAsc group (P = 0.020). The fat necrosis rate was 34.6%. Partial flap necrosis occurred in 13 (44.8%) patients in the DIEP group, and 2 (8.7%) patients in the DIEP-TAsc group (P = 0.004). The partial flap necrosis rate was 28.8%. Total flap necrosis occurred in 5 (17.2%) patients in the DIEP group, but no (0%) patient in the DIEP-TAsc group (P = 0.036). The total flap necrosis rate was 9.6%. The mean operative time was 405 minutes (range, 355-460) in the DIEP group, and 510 minutes (range, 405-590) in the DIEP-TAsc group (P0.001).Thoracoacromial venous supercharging using the ipsilateral superficial inferior epigastric vein is a valuable method which considerably secures the DIEP free flap in breast reconstruction although it lengthens the operative procedure. EBM level: Level III.

INTRODUCTION: For slim patients eligible to breast reconstruction, clinical concerns exist on availability of adequate amount of donor tissue to restore breast volume and challenges in donor-site c ...

The aim of this study is to investigate neovascularisation patterns in the presence of scar tissue and to compare the venous vs arterial components of the scar penetrating neovascularisation.Forty male Spraque-Dawley Rats, which were divided into four groups, were used for this study. At the beginning of the study a vertical midline abdominal incision was made to all animals. Six weeks after the incisions were made, epigastric flaps based on inferior epigastric vessels were raised. In the first group both left and right epigastric artery and veins were protected. In the second group only the right epigastric artery and vein was protected. In the third group, besides the right epigastric artery and vein, only the left epigastric artery was kept intact. In the fourth group, besides the right epigastric artery and vein, only the left epigastric vein was kept intact.The percentages of necrotic areas on the flaps were statistically evaluated. The percentages of the necrotic areas on the left side of the flaps were significantly higher in the second group (p = 0.0305). Total flap area necrosis was also significantly higher in the second group (p = 0.026). In each group, vessel formations were identified which were extending through the midline scar tissue in the angiographic evaluations.These results suggest that scar penetrating neovascularisation on an epigastric flap with one sided pedicle, which is supported by a vein or an artery on the contralateral side, can be enough to facilitate the flap circulation.

Background: There continues to be controversy about performing abdominoplasty concurrently with abdominal liposuction. The concern is that liposuction on the already vascularly compromised abdominal flap will lead to increased complications and flap necrosis. The central abdomen is supplied by the epigastric system. If perforator vessels from this system are spared, the blood supply to the abdomen can be spared and liposuction should be able to be safely performed on the elevated abdominal flap. The purpose of this study was to evaluate the safety of abdominoplasty with concurrent abdominal liposuction when a perforator vessel is spared. Methods: A standard abdominoplasty was performed, sparing one or two perforator vessels from the deep superior epigastric artery system. A retrospective chart review of 300 consecutive patients who underwent abdominoplasty surgery combined with concurrent abdominal liposuction was performed. Complications, total volume of abdominal liposuction, and results were reviewed. Results: The overall complication rate was 17.3 percent (52 patients). Sixteen percent (48 patients) suffered minor complications and 1.3 percent (four patients) suffered major complications. Conclusions: Abdominoplasty can be combined safely with concurrent abdominal liposuction when a perforator vessel is spared. The combination of concurrent liposuction with abdominoplasty showed no increase in complication rates when a perforator vessel was spared. The perforator vessels are located consistently in a 2-cm radius located 4 cm from the midline and 6 cm from the subcostal margin. The potential advantages of abdominoplasty with concurrent liposuction include a better postoperative cosmetic result. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.