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Microvascular aspects of deep inferior epigastric perforator flap revascularization in breast reconstruction

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Abstract

Because of the high incidence of breast cancer in the population, breast reconstruction remains actual after complex cancer treatment.Aim. To characterise revascularization methods based on deep inferior epigastric perforator flaps (DIEP flap), test the frequency and risk factors for perfusion related complications. Materials and methods. The study included 157 patients, with 190 reconstructions performed. The tactics of choosing donor and recipient vessels were determined using an intraoperative assessment of the dominant blood supply system: sample with blood flow stop.Results. In most reconstructions, the deep inferior epigastric arteries were the main source of blood supply to the flap. Non - standard revascularization was required in 14% of cases and was associated with prior interventions on the anterior abdominal wall or individual characteristics of its blood supply. Venous super - drainage was performed in 30% of cases. Most often, the perforating veins of the anterior chest and the retrograde pedicle of the internal chest vein were used as recipient vessels. Complete flap loss occurred in 2% of cases. We observed perfusion complications in 17% of cases, statistically significantly more often in smokers ( p <0.001). A history of radiation therapy as an independent risk factor was not associated with an increase in the frequency of complications. The combination of risk factors “smoking + radiation therapy” was observed more often in patients with perfusion complications ( p =0.042). Imposing additional venous drainage was associated with a statistically significant decrease in the frequency of perfusion disorders: 2% among all flaps with venous super - drainage and 23% without drainage ( p <0.001).Conclusion. Intraoperative assessment of the dominant blood supply system using a sample with blood flow stop allows you to determine the nature of the dominant systems of arterial inflow and venous outflow in the DIEP flap accurately. Risk factors for the development of perfusion complications are smoking and previous radiation therapy in combination with smoking.

About the Authors

M. Ye. Sinelnikov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation


O. I. Starceva
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation


D. V. Melnikov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation


S. I. Ivanov
Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation


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ISSN 2218-7332 (Print)
ISSN 2658-3348 (Online)