Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction
Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotatio...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2020-09-01
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| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2019.01319 |
| _version_ | 1828234712312709120 |
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| author | Ya-han Yu Dina Ghorra Christine Bojanic Oti N. Aria Louise MacLennan Charles M. Malata |
| author_facet | Ya-han Yu Dina Ghorra Christine Bojanic Oti N. Aria Louise MacLennan Charles M. Malata |
| author_sort | Ya-han Yu |
| collection | DOAJ |
| description | Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy. |
| first_indexed | 2024-04-12T20:00:41Z |
| format | Article |
| id | doaj.art-fb7d0d05c1e940039cc5b9a3cd76e7b7 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-12T20:00:41Z |
| publishDate | 2020-09-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-fb7d0d05c1e940039cc5b9a3cd76e7b72022-12-22T03:18:32ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712020-09-01470547348210.5999/aps.2019.013193774Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstructionYa-han Yu0Dina Ghorra1Christine Bojanic2Oti N. Aria3Louise MacLennan4Charles M. Malata5Clinical School of Medicine, University of Cambridge, Cambridge, UKDepartment of Plastic and Reconstructive Surgery, Alexandria Faculty of Medicine, Alexandria University Hospital, Alexandria, EgyptDepartment of Plastic and Reconstructive Surgery, Addenbrooke’s University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UKDepartment of Plastic and Reconstructive Surgery, Addenbrooke’s University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UKDepartment of Plastic and Reconstructive Surgery, Addenbrooke’s University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UKDepartment of Plastic and Reconstructive Surgery, Addenbrooke’s University Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UKSuperficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2019.01319keywordstertiary breast reconstructionmicrosurgical free flapsiea-diep flapbipedicled free flap |
| spellingShingle | Ya-han Yu Dina Ghorra Christine Bojanic Oti N. Aria Louise MacLennan Charles M. Malata Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction Archives of Plastic Surgery keywords tertiary breast reconstruction microsurgical free flap siea-diep flap bipedicled free flap |
| title | Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction |
| title_full | Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction |
| title_fullStr | Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction |
| title_full_unstemmed | Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction |
| title_short | Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction |
| title_sort | orienting the superficial inferior epigastric artery siea pedicle in a stacked siea deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction |
| topic | keywords tertiary breast reconstruction microsurgical free flap siea-diep flap bipedicled free flap |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2019.01319 |
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