Further Validation for Use of the Retrograde Limb of the Internal Mammary Vein in Deep Inferior Epigastric Perforator Flap Breast Reconstruction Using Laser-Assisted Indocyanine Green Angiography

Mohebali, Jahan; Gottlieb, Lawrence J.; Agarwal, Jayant P.

doi:10.1055/s-0029-1243298

Cited by 42 publications

(32 citation statements)

References 9 publications

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“…Following full-text review and consensus, 25 studies were included for analysis using the data abstraction tool . Reasons for exclusion are listed in Figure 1 (29)(30)(31)(32)(33)(34). Overall, one included study was prospective (15) and the remaining 24 were retrospective in design.…”

Section: Resultsmentioning

confidence: 99%

The utility of the microvascular anastomotic coupler in free tissue transfer

Grewal

Erovic

Strumas

et al. 2012

Canadian Journal of Plastic Surgery

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T he transfer of autogenous, vascularized free-tissue is a cornerstone of modern reconstructive surgery, particularly when dealing with extensive oncological ablations and large post-traumatic defects. A half-century after Jacobson and Suarez (1) described the first sutured microvascular anastomosis, the cumulative efforts of surgeons and researchers have refined free tissue transfer (FTT) into a reliable modality that often provides excellent cosmetic and functional results.In addition to adequate presurgical planning and meticulous dissection technique, the microvascular anastomosis is critically important for successful reconstruction. The reported success rate of FTT ranges from 91% to 99%, with the majority of failures being due to technical errors with vessel anastomosis (2). Indeed, a hand-sewn anastomosis is a technically demanding procedure, particularly when dealing with veins, which prompted investigation into alternative strategies to suture. One example is the microvascular anastomotic coupling device (MACD), an interlocking ring-pin design that is becoming more widely used in FTT. Initial animal studies demonstrated favourable tensile characteristics and healing of coupled vessels (3), and subsequent case series in head and neck, breast and limb reconstructive surgery have reported favourably on MACD utilization. These case series have been limited by smaller numbers and variability in reconstructive subsites; however, recently, several larger series have been published. We sought to systematically review the literature to examine the utility of MACD use in FTT with regard to success rates and optimal applications of this device. MethodsA search of PubMed, Ovid MEDLINE, and EMBASE databases (inception to January 2011) was performed using major search terms including "microvascular anastomotic coupler", "anastomotic device", "venous coupler", "Nakayama ring pin" and "free tissue transfer". Two independent reviewers performed the title and abstract review, identifying relevant articles for retrieval. Inclusion criteria were MACD utilization and FTT reconstruction. There was no limitation placed on BACKGrouNd:The microvascular anastomosis remains a technically sensitive and critical determinant of success in free tissue transfer. The microvascular anastomotic coupling device is an elegant, friction-fit ring pin device that is becoming more widely used. oBJeCtive: To systematically review the literature to examine the utility of the microvascular coupler in free tissue transfer. Methods: A comprehensive database search was performed to identify eligible publications. Inclusion criteria were anastomotic coupler utilization and free-tissue transfer. Recorded information from eligible studies included patient age, follow-up, radiation history, number of free-flaps and failure rates, reconstruction subsites, number of coupled venous and arterial anastomoses, coupling time, conversion to sutured anastomosis, coupler size and thrombosis rates. results: Twenty-five studies reporting on 3207 patients were inc...

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Section: Resultsmentioning

confidence: 99%

The utility of the microvascular anastomotic coupler in free tissue transfer

Grewal

Erovic

Strumas

et al. 2012

Canadian Journal of Plastic Surgery

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“…The SIEV can then be anastomosed to augment the blood flow from the superficial to deep systems to the DIEV or its vena comitantes, or as an alternative outflow to other venous networks such as the IMV (retrograde limb or perforator vessels) [95,96], lateral thoracic, thoracodorsal, circumflex scapula, intercostal, cephalic or basilic veins. Regardless of the choice of anastomosis, there is some evidence that the use of an additional venous outflow option can reduce the incidence of flap congestion without affecting flap survival or operating time [84,90].…”

Section: Technique 1: Lowering the Site Of Diep Anastomosismentioning

confidence: 99%

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Rozen

Guio-Aguilar

et al. 2012

Breast Cancer Res Treat

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We outline five methods of preserving the IMA for future CABG: (1) lowering the level of DIEP flaps to the fourth- and fifth-intercostals spaces, (2) using the DIEP pedicle as an intermediary for CABG, (3) using IMA perforators to spare the IMA proper, (4) using and end-to-side anastomosis between the DIEP pedicle and IMA and (5) anastomosis of DIEP flaps using retrograde flow from the distal IMA. With careful patient selection, we hypothesize using the IMA for autologous breast reconstruction need not be an absolute contraindication for future CABG.

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“…13,14 Our group reported retrograde arterial and venous drainage in a double pedicle DIEP flap 15 and has recently studied the retrograde limb of the IMV and determined it to be a viable option as a recipient vein in DIEP breast reconstruction. 16,17 Our cases discuss the use of retrograde anastamoses for flap salvage in breast reconstruction. In our first case, the recipient artery and vein had been avulsed and therefore shortened.…”

Section: Discussionmentioning

confidence: 99%

Salvage of SIEA flaps using the retrograde internal mammary system

2010

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Superficial inferior epigastric artery (SIEA) flaps are ideal for breast reconstruction when the anatomy permits it. Due to the peripheral and superficial location of the pedicle, these flaps can be complicated by vessel kinking against the remaining ribs after insetting. Here, we describe a novel method for SIEA flap salvage after kinking or avulsion of the traditional anastomosis to the internal mammary vessels.

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Further Validation for Use of the Retrograde Limb of the Internal Mammary Vein in Deep Inferior Epigastric Perforator Flap Breast Reconstruction Using Laser-Assisted Indocyanine Green Angiography

Cited by 42 publications

References 9 publications

The utility of the microvascular anastomotic coupler in free tissue transfer

The utility of the microvascular anastomotic coupler in free tissue transfer

Autologous microsurgical breast reconstruction and coronary artery bypass grafting: an anatomical study and clinical implications

Salvage of SIEA flaps using the retrograde internal mammary system

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