کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
4118007 | 1270322 | 2014 | 6 صفحه PDF | دانلود رایگان |
![عکس صفحه اول مقاله: Lateralising paraumbilical medial row perforators: Dangers and pitfalls in DIEP FLAP planning: A systematic review of 1116 DIEP flaps Lateralising paraumbilical medial row perforators: Dangers and pitfalls in DIEP FLAP planning: A systematic review of 1116 DIEP flaps](/preview/png/4118007.png)
SummaryBackgroundThe DIEP flap remains the gold standard for autologous breast reconstruction. Recently, the ‘perforasome concept’ has advanced our understanding of DIEP flap physiology and planning. This study highlights a patient sub-population that produces anomalies to the perforasome hypothesis: those with paramedian, paraumbilical perforators.MethodsOperation notes and pre-operative CT angiograms from 1116 consecutive DIEP flaps were reviewed retrospectively. Patients with paramedian, paraumbilical perforators (n = 153) were contrasted against a control group whose perforators were not paraumbilical (n = 963). Further sub-group analysis was performed within the study group, comparing paraumbilical perforators that held a lateral course within the flap (n = 25) versus those that held a medial course (n = 128).ResultsRates of post-operative DIEP flap partial necrosis was greater in the study population compared with the control group (6.54% vs. 3% p = 0.032). When analysis was made contrasting paraumbilical perforators that held a lateral course in the flap versus perforators that held a median course, flap necrosis was significantly greater in those with a lateral course (24% vs. 3.13%).ConclusionThe perforasome concept has improved our understanding of perfusion from perforators in DIEP flaps. However when the umbilicus presents a physical barrier to blood vessel passage resulting in lateralizing paraumbilical medial row perforators it appears an exception to the “perforasome” rule. Our experience suggests that when a paraumbilical perforator is harvested, a hemi-flap is safe but caution should be exercised when further volume is needed from the contralateral side.
Journal: Journal of Plastic, Reconstructive & Aesthetic Surgery - Volume 67, Issue 3, March 2014, Pages 383–388