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The Stacked Hemiabdominal Extended Perforator Flap for Autologous Breast Reconstruction.

Abstract：

BACKGROUND:Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemiabdominal extended perforator (SHAEP) flap. The authors describe the surgical technique and analyze their results. METHODS:A retrospective study was conducted of all SHAEP flap breast reconstructions performed since February of 2014. Patient demographics, operative details, complications, and flap reexplorations were recorded. The bipedicled hemiabdominal flap was designed as a combination of the deep inferior epigastric artery perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels, the superficial inferior epigastric artery, or a lumbar artery or intercostal perforator. RESULTS:A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range, 405 to 797 minutes). Median hemiabdominal flap weight that was used for reconstruction was 598 g (range, 160 to 1389 g). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2 percent), hematoma (3.3 percent), fat necrosis (2.2 percent), and wound problems (4.4 percent). Minor donor-site complications occurred in five patients (10.2 percent). Most flaps were harvested on a combination of the DIEP and deep circumflex iliac artery vessels. CONCLUSIONS:This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Beugels J,Vasile JV,Tuinder SMH,Delatte SJ,St-Hilaire H,Allen RJ,Levine JL

doi

10.1097/PRS.0000000000005058

subject

Has Abstract

pub_date

2018-12-01 00:00:00

pages

1424-1434

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201812000-00006

journal_volume

142

pub_type

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The Stacked Hemiabdominal Extended Perforator Flap for Autologous Breast Reconstruction.