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Two Cases of the Vascular Territory of a Single-pedicled Deep Inferior Epigastric Perforator Flap with a Vertical Midline Abdominal Scar
: The deep inferior epigastric perforator (DIEP) flap is becoming the gold standard for breast reconstruction using autologous tissue. If there are scars in the abdomen from previous surgery, it is necessary to judge the indication for using this flap carefully. Particularly in cases with vertical m...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253241/ https://www.ncbi.nlm.nih.gov/pubmed/32537343 http://dx.doi.org/10.1097/GOX.0000000000002684 |
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author | Morita, Daiki Numajiri, Toshiaki Nakamura, Hiroko Yamochi, Ryo Tsujiko, Shoko Sowa, Yoshihiro Moriguchi, Yoshio |
author_facet | Morita, Daiki Numajiri, Toshiaki Nakamura, Hiroko Yamochi, Ryo Tsujiko, Shoko Sowa, Yoshihiro Moriguchi, Yoshio |
author_sort | Morita, Daiki |
collection | PubMed |
description | : The deep inferior epigastric perforator (DIEP) flap is becoming the gold standard for breast reconstruction using autologous tissue. If there are scars in the abdomen from previous surgery, it is necessary to judge the indication for using this flap carefully. Particularly in cases with vertical midline scars, the blood flow supply to the zone II can be compromised. Even when patients have a median abdominal scar, it has been reported that the blood flow can extend beyond the scar and reach several centimeters to about half of zone II. We performed breast reconstruction using DIEP flaps for 2 patients with vertical midline scars in the lower abdomen. Indocyanine green angiography was conducted intraoperatively to confirm the vascular territory with a single pedicle before cutting off the flap. One patient showed fluorescence contrast on the contralateral side across the midline scar. However, the fluorescence contrast was absent across the midline scar in the other patient. Based on this result, we investigated the possible vascular territory of a single pedicled DIEP flap in patients with vertical midline abdominal scars. We suggest that successful blood supply to zone II of a single-pedicled DIEP flap in a patient with a vertical midline abdominal scar is related to the location of the perforator and the property of the tissue in the midline near the perforator. However, because it is difficult to predict the vascular territory of a single pedicle before surgery, intraoperative evaluation using such techniques such as indocyanine green fluorescence imaging is important. |
format | Online Article Text |
id | pubmed-7253241 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-72532412020-06-11 Two Cases of the Vascular Territory of a Single-pedicled Deep Inferior Epigastric Perforator Flap with a Vertical Midline Abdominal Scar Morita, Daiki Numajiri, Toshiaki Nakamura, Hiroko Yamochi, Ryo Tsujiko, Shoko Sowa, Yoshihiro Moriguchi, Yoshio Plast Reconstr Surg Glob Open Case Report : The deep inferior epigastric perforator (DIEP) flap is becoming the gold standard for breast reconstruction using autologous tissue. If there are scars in the abdomen from previous surgery, it is necessary to judge the indication for using this flap carefully. Particularly in cases with vertical midline scars, the blood flow supply to the zone II can be compromised. Even when patients have a median abdominal scar, it has been reported that the blood flow can extend beyond the scar and reach several centimeters to about half of zone II. We performed breast reconstruction using DIEP flaps for 2 patients with vertical midline scars in the lower abdomen. Indocyanine green angiography was conducted intraoperatively to confirm the vascular territory with a single pedicle before cutting off the flap. One patient showed fluorescence contrast on the contralateral side across the midline scar. However, the fluorescence contrast was absent across the midline scar in the other patient. Based on this result, we investigated the possible vascular territory of a single pedicled DIEP flap in patients with vertical midline abdominal scars. We suggest that successful blood supply to zone II of a single-pedicled DIEP flap in a patient with a vertical midline abdominal scar is related to the location of the perforator and the property of the tissue in the midline near the perforator. However, because it is difficult to predict the vascular territory of a single pedicle before surgery, intraoperative evaluation using such techniques such as indocyanine green fluorescence imaging is important. Wolters Kluwer Health 2020-03-11 /pmc/articles/PMC7253241/ /pubmed/32537343 http://dx.doi.org/10.1097/GOX.0000000000002684 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Case Report Morita, Daiki Numajiri, Toshiaki Nakamura, Hiroko Yamochi, Ryo Tsujiko, Shoko Sowa, Yoshihiro Moriguchi, Yoshio Two Cases of the Vascular Territory of a Single-pedicled Deep Inferior Epigastric Perforator Flap with a Vertical Midline Abdominal Scar |
title | Two Cases of the Vascular Territory of a Single-pedicled Deep Inferior Epigastric Perforator Flap with a Vertical Midline Abdominal Scar |
title_full | Two Cases of the Vascular Territory of a Single-pedicled Deep Inferior Epigastric Perforator Flap with a Vertical Midline Abdominal Scar |
title_fullStr | Two Cases of the Vascular Territory of a Single-pedicled Deep Inferior Epigastric Perforator Flap with a Vertical Midline Abdominal Scar |
title_full_unstemmed | Two Cases of the Vascular Territory of a Single-pedicled Deep Inferior Epigastric Perforator Flap with a Vertical Midline Abdominal Scar |
title_short | Two Cases of the Vascular Territory of a Single-pedicled Deep Inferior Epigastric Perforator Flap with a Vertical Midline Abdominal Scar |
title_sort | two cases of the vascular territory of a single-pedicled deep inferior epigastric perforator flap with a vertical midline abdominal scar |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253241/ https://www.ncbi.nlm.nih.gov/pubmed/32537343 http://dx.doi.org/10.1097/GOX.0000000000002684 |
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