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Bilateral Breast Reconstruction with Extended Thoracodorsal Artery Perforator Propeller Flaps and Implants.

Gunnarsson GL, Børsen-Koch M, Nielsen HT, Salzberg A, Thomsen JB - Plast Reconstr Surg Glob Open (2015)

Bottom Line: Reconstruction was successfully achieved in all cases with few complications.The median time for surgery was 275 minutes (200-330), and the average implant size used was 350 cm(3) (195-650).We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium of techniques for single-stage bilateral breast reconstruction.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery, Telemark Hospital, Skien, Norway; Department of Plastic Surgery, Lillebaelt Hospital/Odense University Hospital, Vejle, Denmark; Department of Plastic Surgery, Odense University Hospital, Odense, Denmark; and Division of Plastic Surgery, Mount Sinai Medical System, N.Y.

ABSTRACT
We present our experience of bilateral total breast reconstruction using a double-sided extended thoracodorsal artery perforator propeller flap in a case series of 10 patients. Reconstruction was successfully achieved in all cases with few complications. The median time for surgery was 275 minutes (200-330), and the average implant size used was 350 cm(3) (195-650). We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium of techniques for single-stage bilateral breast reconstruction.

No MeSH data available.


Surgical technique.
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Figure 2: Surgical technique.

Mentions: The surgical technique of the propeller TAP flap has been described and illustrated for unilateral cases in a recent paper by the authors.4 The key steps in brief are identification of the dominating perforators deriving from the thoracodorsal artery by color Doppler ultrasonography and design of an oblique downward skin paddle marked within the boundaries of the LD muscle4,14 (Fig. 1). The main difference between the unilateral and the bilateral case is the patient positioning. The flaps were raised in a subfascial plane. We used an “extended” flap design, extending the skin island subcutaneously 2–3 cm on each side at the level of the deep fascia to allow for a bigger flap and better vascularity but still enabling a direct donor site closure. The fasciocutaneous flaps are raised with the patient in the prone position using a monopolar cautery until the perforator is approached, and then the dissection is continued somewhat slower until the perforator is visualized and finalized using Stevens scissors. Simultaneous flap dissection can easily be carried out in this fashion starting with a relatively inexperienced assistant on the opposite side. Sufficient tissue was released around the perforators to ensure a tension-free rotation of the flap. The perforator(s) was neither skeletonized nor dissected through the muscle. We dissected the recipient site cavity through a lateral access using the monopolar cautery. The flaps were then transposed to the breast site, before turning the patient to the supine position. In case the recipient site is severely damaged by scar tissue, it is our experience that it is advantageous to dissect the mastectomy pocket and release the axillary scar tissue in the supine position before turning the patient to the prone position for flap harvesting. The donor site was closed in 2 layers using either a running absorbable 0 monofilament or interrupted 2.0 braided suture in the deep dermis followed by intracutaneous 3.0 absorbable monofilament suture without placement of drains and the patient turned to the supine position (Fig. 2).


Bilateral Breast Reconstruction with Extended Thoracodorsal Artery Perforator Propeller Flaps and Implants.

Gunnarsson GL, Børsen-Koch M, Nielsen HT, Salzberg A, Thomsen JB - Plast Reconstr Surg Glob Open (2015)

Surgical technique.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494505&req=5

Figure 2: Surgical technique.
Mentions: The surgical technique of the propeller TAP flap has been described and illustrated for unilateral cases in a recent paper by the authors.4 The key steps in brief are identification of the dominating perforators deriving from the thoracodorsal artery by color Doppler ultrasonography and design of an oblique downward skin paddle marked within the boundaries of the LD muscle4,14 (Fig. 1). The main difference between the unilateral and the bilateral case is the patient positioning. The flaps were raised in a subfascial plane. We used an “extended” flap design, extending the skin island subcutaneously 2–3 cm on each side at the level of the deep fascia to allow for a bigger flap and better vascularity but still enabling a direct donor site closure. The fasciocutaneous flaps are raised with the patient in the prone position using a monopolar cautery until the perforator is approached, and then the dissection is continued somewhat slower until the perforator is visualized and finalized using Stevens scissors. Simultaneous flap dissection can easily be carried out in this fashion starting with a relatively inexperienced assistant on the opposite side. Sufficient tissue was released around the perforators to ensure a tension-free rotation of the flap. The perforator(s) was neither skeletonized nor dissected through the muscle. We dissected the recipient site cavity through a lateral access using the monopolar cautery. The flaps were then transposed to the breast site, before turning the patient to the supine position. In case the recipient site is severely damaged by scar tissue, it is our experience that it is advantageous to dissect the mastectomy pocket and release the axillary scar tissue in the supine position before turning the patient to the prone position for flap harvesting. The donor site was closed in 2 layers using either a running absorbable 0 monofilament or interrupted 2.0 braided suture in the deep dermis followed by intracutaneous 3.0 absorbable monofilament suture without placement of drains and the patient turned to the supine position (Fig. 2).

Bottom Line: Reconstruction was successfully achieved in all cases with few complications.The median time for surgery was 275 minutes (200-330), and the average implant size used was 350 cm(3) (195-650).We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium of techniques for single-stage bilateral breast reconstruction.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery, Telemark Hospital, Skien, Norway; Department of Plastic Surgery, Lillebaelt Hospital/Odense University Hospital, Vejle, Denmark; Department of Plastic Surgery, Odense University Hospital, Odense, Denmark; and Division of Plastic Surgery, Mount Sinai Medical System, N.Y.

ABSTRACT
We present our experience of bilateral total breast reconstruction using a double-sided extended thoracodorsal artery perforator propeller flap in a case series of 10 patients. Reconstruction was successfully achieved in all cases with few complications. The median time for surgery was 275 minutes (200-330), and the average implant size used was 350 cm(3) (195-650). We demonstrate how the extended thoracodorsal artery perforator propeller flap allows for a swift and reliable direct to implant bilateral total breast reconstruction in a simple setting and is a valuable adjunct to our armamentarium of techniques for single-stage bilateral breast reconstruction.

No MeSH data available.