Oncoplastic Flap Surgery: Breast Reconstruction

Foreword 1
Foreword 2
Preface
Contents
Contributors
1: Breast Reconstruction with Autologous Tissue Transplantation
1.1 Breast Cancer and Mastectomy
1.2 Breast Reconstruction with Autologous Tissue Flap
1.3 Free-Styled Flap
1.3.1 Skin Tube
1.4 Latissimus Dorsi Flap
1.5 Abdominal Flap
1.6 Free Tissue Flap Transplantation
1.7 Perforator Flap Base on the Deep Inferior Epigastric Artery
1.8 Other Abdominal Perforator Flaps
1.9 Muscle Sparing Latissimus Dorsi (MSLD) Flap, Thoracodorsal Artery Perforator Flap, and Intercostal Artery Perforator Flap
1.10 Hip Flap
1.11 Lumbar Artery Perforator Flap
1.12 Thigh Flap
1.13 Transverse Upper Gracilis (TUG) Myocutaneous Flap
1.14 Perforator Flap of Profunda Femoral Artery
1.15 Progress of Breast Reconstruction
1.15.1 Autologous Fat Injection
1.15.2 Upper Limb Lymphedema
1.16 The Future of Breast Reconstruction
References
2: History of DIEP Flap in Breast and Chest Wall Reconstruction
2.1 Background and Development of Inferior Abdominal Artery Perforator Flap for Breast Reconstruction and Chest Wall Reconstruction
2.1.1 Advantages and Disadvantages
2.1.2 Indications
2.1.3 Contraindication
2.1.4 Preoperative Planning
2.1.5 Anatomy
2.1.6 Surgical Technique
2.1.7 Postoperative Management
2.1.8 Complications
2.1.9 Summary
References
3: The Importance of Preserving Intercostal Nerves
3.1 Process Steps of Actual Surgical Separation of Intercostal Nerves (Figs. 3.4, 3.5, 3.6, 3.7, 3.8, and 3.9)
3.1.1 Case 1: Preserving the Intercostal Nerves When Separating the DIEPs
References
4: Raising the DIEP Flap on Cadaver
4.1 Introduction
4.2 Steps of a DIEP FLAP Raising on Cadaver
References
5: The DIEA Branching Pattern and Its Relationship to Perforators
5.1 The Number of Perforating Branches of Deep Inferior Epigastric Vessels
5.1.1 Case 1: Anatomical Type of Perforating Branch
5.1.2 Case 2: Multiple Perforator Pattern
5.2 Anatomical Types of DIEPs Based on Running Pattern
5.2.1 Case 3: Muscular Septal Perforating Branch of Deep Inferior Epigastric Artery
5.2.2 Case 4: Muscular Septal Perforating Branch of Inferior Epigastric Artery
5.2.3 Case 5: Superficial Medial Vascular Branch of Deep Inferior Epigastric Artery
5.2.4 Case 6: DIEP Flap Containing Both the Medial and Lateral Perforating Branches
References
6: Adjustment of Vascular Body Area of DIEP Flap
6.1 Case 1: Adjustment of Vascular Body Area of DIEP Flap
6.1.1 Anatomical Territory
6.1.2 Hemodynamic Donor Territory
6.1.3 Potential Territory
6.2 Case 2: A DIEP Flap Pedicled with a Paraumbilical Perforator of the Lateral Branch
6.3 Case 3: A DIEP Flap Pedicled with Perforators of the Lateral Branch
6.4 Case 4: A DIEP Flap Pedicled with Lateral Perforators
References
7: Various Forms of DIEP Flaps
7.1 Transverse Perforator Flap of Deep Inferior Epigastric Artery
7.1.1 Case 1: Transverse Perforator Flap of Deep Inferior Epigastric Artery
7.2 Vertical DIEP Flap
7.2.1 Case 2: The Vertical DIEP Flap (Figs. 7.16, 7.17, 7.18, 7.19, 7.20, 7.21, 7.22, and 7.23)
7.3 Oblique Design of DIEP Flap
7.3.1 Case 3: An Oblique DIEP Flap with Sensation
7.4 Polyflaps Based on DIEP
7.4.1 Case 4: Polyflaps Based on DIEP
7.4.2 Case 5: Polyflaps DIEP Flap
7.4.3 Case 6: Lobed DIEP Flap
7.5 Microsurgical Debulking of the DIEP Flap
7.5.1 Case 7: Microdissected Thin DIEP Flap with Multiple Perforators
7.5.1.1 Super-Thin Perforator Flap
7.6 De-epithelized DIEP Flap
7.6.1 Case 8: De-epithelized DIEP Flap
7.7 Chimeric DIEP Flap
7.7.1 Case 9: Chimeric DIEP Flap with Muscle Flap (Figs. 7.73, 7.74, 7.75, 7.76, and 7.77)
References
8: Modified Auxiliary Incision for Flap Removal
8.1 Case 1: Modified Auxiliary Incision for Raising a DIEP Flap
9: Unilateral Pedicled TRAM Flap Plus Contralateral Free DIEP Flap
9.1 Combined Flap
9.2 Siamese Flap
9.3 Case 1: Pedicled RAM Flap Combined with Free DIEP Flap with the Lateral Thoracic Vessels as Recipient Vessels
9.4 Case 2: Pedicled Rectus Abdominis Flap Combined with Free Perforator Flap of Deep Inferior Epigastric Artery: The Thoracoacromial Vessels as Recipient
9.5 Case 3: Pedicled Rectus Abdominis Flap Combined with Free Perforator Flap of Deep Inferior Epigastric: An Anterior Serratus Branch of the Thoracodorsal Vessels as Recipient
References
10: Strategies for Improving Venous Drainage in DIEP Flap for Chest Wall and Breast Reconstruction
10.1 Introduction
10.2 Anatomy Essentials
10.3 Preoperative Management
10.4 Intraoperative Management
10.5 Management of Venous Congestion
10.5.1 Microscopic Exploration
10.5.2 Pressure Reduction
10.5.3 Flap Trimming
10.5.4 Replacement of Vascular Pedicle
10.5.5 Selection and Preparation of Recipient Vessels
10.5.6 Flexible Application of Superficial Epigastric Vein
10.5.7 Non-microsurgical Approach for Flap Salvage
10.5.8 Flap Necrosis and Remedial Measures
10.5.9 Postoperative Management
10.6 Case 1: A DIEP Flap Supercharged Using Ipsilateral Superficial Epigastric Vein
10.7 Case 2: A DIEP Flap with SIEV Revascularization
10.8 Case 3: Breast Reconstruction Using DIEP Flap and SIEV
10.9 Case 4: DIEP Flap Including SIEV for Reconstruction
References
11: Bipedicled Turbocharged DIEP Flaps for Unilateral Breast Reconstruction
11.1 Introduction
11.1.1 Turbocharge
11.2 The Indications and Advantages of Turbocharge
11.3 Case 1: Turbocharge
11.4 Case 2: Turbocharged DIEP Flap
References
12: Bipedicled Supercharged DIEP Flap for Unilateral Breast Reconstruction
12.1 Indications
12.2 Surgical Methods and Imaging Features of Double Pedicled Perforator Flap of Deep Inferior Epigastric Artery
12.3 Case Study 1: Bipedicled Supercharged DIEP Flap Using the Proximal and Distal Internal Mammary Vessels as Recipient Vessels
12.4 Case Study 2: Supercharged Vascular Anastomosis: The Anterior Serratus Branch of Thoracodorsal Vessel and the Proximal End of Internal Thoracic Vessels Were Used as Recipient Vessels
12.5 Case Study 3: Supercharged DIEP Flap Using Internal Mammary Vessels and Lateral Thoracic Vessels as Recipient
12.5.1 Supercharge
12.5.2 Turbocharge
12.6 Case 4: Bipedicled DIEP Flap for Breast Reconstruction
12.7 Summary
References
13: Bilateral Simultaneous Breast Reconstruction with Bilateral DIEP Flaps
References
14: Free DIEP Combined with SIEAP Flap for Unilateral Breast Reconstruction
14.1 Indications and Contraindications
14.1.1 Anatomy
14.2 Matters Needing Attention
14.2.1 Perfusion Evaluation
14.2.2 Adjustment of Flap Placement
14.2.3 Abdominal Drainage
14.2.4 Postoperative Monitoring
14.3 Case 1: DIEP + SIEAP Breast Reconstruction
14.3.1 Flap Adjustment
14.4 Case 2: DIEP + SIEAP Breast Reconstruction 2
References
15: Simultaneous Contralateral Breast Reduction/Mastopexy with Unilateral Breast Reconstruction Using Free DIEP Flaps
15.1 Background
15.2 Timing of Operation
15.3 Preoperative Design and Donor Site Preparation
References
16: Sensory Reconstruction for the Reconstructed Breast
16.1 Selecting Nerves
References
17: Free DIEP Flap with Ilioinguinal Lymphoid Tissue for Breast Reconstruction and Treatment of Upper Limb Lymphedema
17.1 Summary
17.2 Surgical Methods
17.2.1 Flap Design
17.2.2 Receiving Area Preparation
17.2.3 Flap Raising
17.2.4 Breast Reconstruction and Vascular Anastomosis
17.2.5 Postoperative Treatment
17.3 Discussion
References
18: Experience Sharing in Handling Difficult Cases of Breast Reconstruction with DIEP Flap
18.1 Risk Avoidance of Breast Reconstruction
18.1.1 Downsides of Flap Raising in This Case
18.1.2 Scheme 1 Summary
18.1.3 Redesign Scheme 2 (Fig. 18.47)
18.1.4 Vascular Pedicle Repair and Repositioning
18.1.5 Experience and Lessons of Surgical Failure
18.2 Summary of the Perioperative Precautions of Breast Reconstruction and Chest Wall Reconstruction
18.2.1 Preoperative Preparation
18.2.2 Postoperative Treatment Plan
References
19: Evolution, Anatomy, Advantages and Disadvantages, and Harvest Techniques of Profunda Artery Perforator Flap
19.1 History
19.2 Vascular Anatomy
19.3 Indication
19.4 Preoperative Design
19.5 Operation Process
19.6 Postoperative Care
19.7 Discussion
19.8 Conclusions
References
20: Vascular Variations and Approaches of PAP Flap
20.1 Anatomy
20.1.1 Preoperative Planning/Flap Design
20.2 Discussion of Clinical Experience
20.3 Typical Case 1: Medial Femoral Flap Pedicled with Direct Perforating Branch of the Femoral Artery
20.4 Typical Case 2: Adductor Longus Perforator Flap Pedicled with Profunda Femoral Artery
20.5 Typical Case 3: Profunda Femoral Artery Adductor Longus Perforator Gracilis Chimeric Myocutaneous Flap
20.6 Typical Case 4: Profunda Femoral Artery Pedicled Adductor Longus Perforator Chimeric Gracilis Myocutaneous Flap
20.7 Typical Case 5: An Example of Excision of the Gracilis Muscle Perforator Chimeric Myocutaneous Flap
20.8 Typical Case 6: Multi-Perforator Profunda Femoral Artery Perforator Flap with Partial Gracilis Muscle
20.9 Typical Case 7: Gracilis Myocutaneous Flap for Muscle Functional Reconstruction
20.10 Typical Case 8: Pure Gracilis Perforator Flap
20.11 Typical Case 9: Profunda Femoral Artery Pedicled Gracilis Perforator Chimeric Myocutaneous Flap
20.12 Typical Case 10: Gracilis Perforator Chimeric Myocutaneous Flap (Figs. 20.51, 20.52, 20.53, 20.54, 20.55, and 20.56)
20.13 Typical Case 11: Adductor Longus Perforator Chimeric Gracilis Myocutaneous Flap
20.14 Typical Case 12: Adductor Major Perforator Flap Pedicled with Profunda Femoral Artery
20.15 Typical Case 13: Chimeric Gracilis Myocutaneous Flap Pedicled with Perforating Branch of the Adductor Major
20.16 Typical Case 14: Chimeric Gracilis Myocutaneous Flap Pedicled with the Perforating Branch of the Adductor Major While Preserving the Anterior Branch of the Obturator Nerve
20.17 Typical Case 15: Great Adductor Perforator-Embedded Gracilis Myocutaneous Flap
20.18 Typical Case 16: Profunda Femoral Artery Pedicled Adductor Major Perforator Chimeric Adductor Major Myocutaneous Flap
20.19 Typical Case 17: Chimeric Adductor Major Myocutaneous Flap
20.20 Typical Case 18: Supercharged Adductor Major Perforator Myocutaneous Flap
20.21 Typical Case 19: Supercharged Chimeric Adductor Major Myocutaneous Flap
20.22 Typical Case 20: Supercharged Dual-Perforator Pedicled Adductor Major Perforator Flap and Donor Area Reconstructed by the Gracilis Myocutaneous Flap in Relay
20.22.1 Clinical Thinking
20.23 Typical Case 21: Semimembranosus Muscle Chimeric Perforator Myocutaneous Flap
20.24 Conclusion
References
21: Transverse Gracilis Musculocutaneous Flap for Breast Reconstruction
21.1 Applied Anatomy
21.2 Flap Design
21.3 Tumor Resection and Recipient Site Preparation
21.4 Flap Cutting
21.5 Breast Reconstruction and Vascular Anastomosis
21.6 Postoperative Treatment
21.7 A Typical Case of Breast Reconstruction with Gracilis Myocutaneous Flap
References
22: Single Pedicled Profunda Femoral Artery Perforator Flap for Breast Reconstruction
22.1 A Typical Case of Breast Reconstruction with Single Vessel Pedicled Profunda Femoral Artery Perforator Flap
References
23: Free Gracilis Myocutaneous Flap Combined with Profunda Femoral Artery Perforator Flap for Breast Reconstruction
23.1 Gracilis Myocutaneous Flap Combined with Profunda Femoral Artery Perforator Flap for Breast Reconstruction: A Typical Case
23.2 Gracilis Myocutaneous Flap Combined with Profunda Femoral Artery Perforator Flap for Breast Reconstruction: A Typical Case 2
23.3 Gracilis Myocutaneous Flap Combined with Profunda Femoral Artery Perforator Flap for Breast Reconstruction: Typical Case 3
23.4 Gracilis Myocutaneous Flap Combined with Profunda Femoral Artery Perforator Flap for Breast Reconstruction
23.5 Discussion
23.6 Conclusion
References
24: Double-Pedicled Profunda Femoral Artery Perforator Flap for Breast Reconstruction
24.1 Surgical Technique
24.2 Double-Vessel Pedicled Profunda Femoral Artery Perforator Flap for Breast Reconstruction: A Typical Case
24.3 Breast Reconstruction with Double-Vessel Pedicled Profunda Femoral Artery Perforator Flap: Typical Case 2
24.4 Double-Vessel Pedicled Profunda Femoral Artery Perforator Flap for Breast Reconstruction: Typical Case 3
24.5 Conclusion
References
25: Greater Omental Flap for Breast Reconstruction
25.1 Background
25.2 Indications
25.3 Anatomy
25.4 Advantages and Disadvantages of the Greater Omental Flap and Preoperative Preparation
25.5 Typical Cases of Free Greater Omental Flap
25.6 Design of the Omental Flap for Special Requirements
25.7 Omental Flap Markings
25.8 Surgical Methods
25.9 Precautions for Omental Flap Dissection Technique [27]
25.10 Endoscopic Harvest of the Omental Flap
25.11 Omental Flap Monitoring
25.12 Special Instruments
25.13 Donor Closure and Postoperative Management
25.14 Postoperative Treatment
25.15 Simple Transposition of Pedicled Omental Flap for Breast Reconstruction: Typical Case 1
25.16 Simple Transposition of Pedicled Omental Flap for Breast Reconstruction: Typical Case 2
25.17 Simple Pedicled Omental Flap Transposition for Breast Reconstruction: Typical Case 3
25.18 Simple Transposition of the Pedicled Omental Flap for Breast Reconstruction: Typical Case 4
25.19 Transposition of Pedicled Greater Omentum Flap Combined with Prosthesis Implantation for Breast Reconstruction: Typical Case 1
25.20 Transposition of the Pedicled Omental Flap Combined with Prosthesis Implantation for Breast Reconstruction: Typical Case 2
25.21 Transposition of the Pedicled Omental Flap Combined with Prosthesis Implantation for Breast Reconstruction: Typical Case 3
25.22 Transposition of Pedicled Greater Omentum Flap Combined with Prosthesis Implantation for Breast Reconstruction: Typical Case 4
25.23 Transposition of Pedicled Omental Flap Combined with Prosthesis Implantation for Breast Reconstruction: Typical Case 5
References
26: Application of ICG in Flap Surgery for Oncoplasty
26.1 History of Clinical Application of ICG Angiography
26.1.1 Initial: 1950s, 1960s, and 1970s
26.1.2 Development: Application in Ophthalmology in the 1970s and 1980s
26.1.3 Wide Application: After the 1990s
26.1.4 Clinical Application of ICG in China
26.2 Characteristics of ICG
26.3 Application of ICG Imaging in Breast Reconstruction
26.3.1 Prediction Models and Comparison of Tissue Perfusion During Reconstruction
26.3.2 Application of ICG in Breast Reconstruction
26.3.2.1 ICG Is Used for Breast Reconstruction with Expander and Prosthesis Implantation
26.3.2.2 ICG for Breast Reconstruction with Autologous Tissue Transfer
Locate the Vascular Perforator
The Perforator Perfusion Area Was Recorded in Real Time
To Evaluate the Effect of Microsurgical Anastomosis
Postoperative Observation
26.4 ICG Was Applied to Lower Abdominal Flap with Vertical Incision of Cesarean Section: A Typical Case
26.5 ICG Determined the Number of Vascular Pedicles Required for the Flap: A Typical Case
26.6 ICG for Lower Abdominal Flap Transplantation: A Typical Case
26.6.1 Application of ICG During Operation
26.6.2 Selection of ICG Fluorescence Threshold
26.6.3 Precautions for ICG Application
26.7 Economic Factors of ICG in Breast Reconstruction
26.8 The Future of ICG in Breast Reconstruction
26.9 Summary
References
27: Shaping for Breast Reconstruction with Autologous Tissue Transplantation
27.1 A Case Study of One-Stage Breast Reconstruction with DIEP Flap Transplantation
27.2 DIEP Skin Flap Transplantation for Secondary Breast Reconstruction
27.3 DIEP Skin Flap Transplantation for Secondary Breast Reconstruction: A Complicated Case
27.4 Extensive Scar Due to Chest Wall Radiotherapy Treated by Secondary Breast Reconstruction by Autologous Tissue Flap Transplantation
27.4.1 Difficulties in Preoperative Evaluation
27.4.2 Preoperative Questions
27.4.3 Preoperative Design Response
27.5 Real Difficulties Encountered During Operation
27.6 Gracilis Myocutaneous Flap Combined with Profunda Femoral Artery Perforator Flap for Breast Reconstruction: A Typical Case
27.7 Conclusion
References