Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy
Delayed breast reconstruction is challenging because it requires a large volume and symmetry, and the dual-pedicled deep inferior epigastric perforator (DIEP) flap is used with microvascular augmentation. However, candidate recipient vessels in patients who have undergone radiation therapy may be da...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Korean Society for Aesthetic Plastic Surgery
2021-01-01
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| Series: | Archives of Aesthetic Plastic Surgery |
| Subjects: | |
| Online Access: | http://e-aaps.org/upload/pdf/aaps-2020-02306.pdf |
| _version_ | 1818957574237585408 |
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| author | Jun Hyeok Kim Na Rim Kim Ye Sol Kim Deuk Young Oh |
| author_facet | Jun Hyeok Kim Na Rim Kim Ye Sol Kim Deuk Young Oh |
| author_sort | Jun Hyeok Kim |
| collection | DOAJ |
| description | Delayed breast reconstruction is challenging because it requires a large volume and symmetry, and the dual-pedicled deep inferior epigastric perforator (DIEP) flap is used with microvascular augmentation. However, candidate recipient vessels in patients who have undergone radiation therapy may be damaged, with uncertain patency. This report suggests a novel method, the dual-pedicled conjoined abdominal flap, in which a free DIEP flap is combined with a pedicled transverse rectus abdominis muscle (TRAM) flap. A 57-year-old female patient who had undergone modified radical mastectomy and radiotherapy 25 years previously was referred for breast reconstruction. A whole abdominal flap was needed, but supercharged anastomosis was very risky due to calcification and scarring of the internal mammary vessel. Therefore, the thoracodorsal vessels were anastomosed with a free left DIEP flap, which was combined with a right-pedicled TRAM flap. The reconstructed volume was sufficient, and the blood flow was intact. The patient presented a symmetric contour without any complications after 4 months. The dual-pedicled conjoined abdominal flap is reliable for delayed breast reconstruction that requires a large volume and skin replacement, especially in patients with radiation-injured recipient vessels. Even if microscopic anastomosis failure occurs, secondary rescue is made possible by the pedicled TRAM flap. |
| first_indexed | 2024-12-20T11:12:01Z |
| format | Article |
| id | doaj.art-41b220b3683c48488e37bd1aa77ce0a1 |
| institution | Directory Open Access Journal |
| issn | 2234-0831 2288-9337 |
| language | English |
| last_indexed | 2024-12-20T11:12:01Z |
| publishDate | 2021-01-01 |
| publisher | Korean Society for Aesthetic Plastic Surgery |
| record_format | Article |
| series | Archives of Aesthetic Plastic Surgery |
| spelling | doaj.art-41b220b3683c48488e37bd1aa77ce0a12022-12-21T19:42:44ZengKorean Society for Aesthetic Plastic SurgeryArchives of Aesthetic Plastic Surgery2234-08312288-93372021-01-01271313410.14730/aaps.2020.02306727Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapyJun Hyeok Kim0Na Rim Kim1Ye Sol Kim2Deuk Young Oh Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Plastic and Reconstructive Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, KoreaDelayed breast reconstruction is challenging because it requires a large volume and symmetry, and the dual-pedicled deep inferior epigastric perforator (DIEP) flap is used with microvascular augmentation. However, candidate recipient vessels in patients who have undergone radiation therapy may be damaged, with uncertain patency. This report suggests a novel method, the dual-pedicled conjoined abdominal flap, in which a free DIEP flap is combined with a pedicled transverse rectus abdominis muscle (TRAM) flap. A 57-year-old female patient who had undergone modified radical mastectomy and radiotherapy 25 years previously was referred for breast reconstruction. A whole abdominal flap was needed, but supercharged anastomosis was very risky due to calcification and scarring of the internal mammary vessel. Therefore, the thoracodorsal vessels were anastomosed with a free left DIEP flap, which was combined with a right-pedicled TRAM flap. The reconstructed volume was sufficient, and the blood flow was intact. The patient presented a symmetric contour without any complications after 4 months. The dual-pedicled conjoined abdominal flap is reliable for delayed breast reconstruction that requires a large volume and skin replacement, especially in patients with radiation-injured recipient vessels. Even if microscopic anastomosis failure occurs, secondary rescue is made possible by the pedicled TRAM flap.http://e-aaps.org/upload/pdf/aaps-2020-02306.pdfbreast reconstructionradiationfree tissue flapspedicled flap |
| spellingShingle | Jun Hyeok Kim Na Rim Kim Ye Sol Kim Deuk Young Oh Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy Archives of Aesthetic Plastic Surgery breast reconstruction radiation free tissue flaps pedicled flap |
| title | Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy |
| title_full | Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy |
| title_fullStr | Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy |
| title_full_unstemmed | Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy |
| title_short | Dual-pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy |
| title_sort | dual pedicled conjoined abdominal flap for breast reconstruction in a patient with previous radiation therapy |
| topic | breast reconstruction radiation free tissue flaps pedicled flap |
| url | http://e-aaps.org/upload/pdf/aaps-2020-02306.pdf |
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