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Semin Plast Surg 2002; 16(1): 061-068
DOI: 10.1055/s-2002-22681
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Breast Reconstruction with Free Bipedicled TRAM or DIEP Flaps by Anastamosis to the Proximal and Distal Ends of the Internal Mammary Vessels

Lanhua Mu1 , Jun Xu1 , Yuanbo Liu1 , Xiaofeng Zhu1 , Senkai Li1 , Yangqun Li, Robert J. Allen2
  • 1Plastic Surgery Hospital (Institute), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P.R. of China
  • 2Section of Plastic Surgery, Louisiana State University, Medical Center, New Orleans, LA
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Publikationsdatum:
22. März 2002 (online)

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ABSTRACT

Breast reconstruction in patients who have already undergone traditional radical mastectomy can be very challenging for plastic surgeons. These patients require not only correction of breast deformities but also correction of subclavian and anterior axillary fold deformities. Usually the entire transverse rectus abdominal myocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flap (including zone IV) must be used. To achieve this, bipedicled deep inferior epigastric vessels (DIEV) are needed to ensure that the entire flap will survive completely. On the chest, however, it is difficult to find two sets of suitable recipient vessels for the two pedicles. The thoracodorsal vessels have often been damaged during axillary dissection or radiation therapy. In the past, surgeons have used the proximal end of the internal mammary artery and vein (IMA, IMV) as the recipient vessels in breast reconstruction with free flaps, with ligation of the distal ends. Here, we use both the proximal and distal ends of IMA and IMV as recipient vessels for end-end anastomoses to the bipedicled deep inferior epigastric artery and deep inferior epigastric vein vessels in seven TRAM cases and five DIEP cases. Very satisfactory results are obtained. Our clinical and experimental studies indicate that the distal IMA has reduced perfusion pressure but still can provide excellent flow and flap perfusion. This technique allows reliable use of two pedicles for survival of the entire flap.

KEYWORD

Bipedicled deep inferior epigastric perforator flap - free transverse rectus abdominal myocutaneous flap - proximal and distal ends of internal mammary artery - breast reconstruction

REFERENCES

  • 1 Fujino T, Harashina T, Aoyagi F. Reconstruction for aplasia of the breast and pectoral region by microvascular transfer of a free flap from the buttock.  Plast Reconstr Surg . 1975;  56 178-181
    Google Scholar
  • 2 Fujino T, Harashina T, Enomoto K. Primary breast reconstruction after a standard radical mastectomy by a free flap transfer.  Plast Reconstr Surg . 1976;  58 371-375
    Google Scholar
  • 3 Shaw W W. Breast reconstruction by superior gluteal microvascular free flaps without silicon implants.  Plast Reconstr Surg . 1983;  72 490-501
    Google Scholar
  • 4 Senkai L, Yangqun L, Jun X. Breast reconstruction with free superior gluteal microvascular flap (one case report.) Chin J Plast Surg Burns .  1990;  6 228-229
    PubMedGoogle Scholar
  • 5 Blondeel P N, Boeckx W D. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery.  Br J Plast Surg . 1994;  47 495-501
    Google Scholar
  • 6 Green G E, Sterzer S H, Reppert E H. Coronary artery bypass grafts.  Ann Thorac Surg . 1968;  5 443-446
    Google Scholar
  • 7 Vineberg A, Wright J. A Myocardial Revascularization by Arterial/Ventricular Implants.  Boston, MA: PSG, Inc. 1982: 59-150
    Google Scholar
  • 8 Van Son A J, Smedts F. Histology of the internal mammary artery versus the inferior epigastric artery.  Ann Thorac Surg . 1992;  53 1147-1149
    Google Scholar
  • 9 Girerd X J, Acar C, Mourad J J. Incompressibility of the human arterial wall: an in vitro ultrasound study.  J Hypertens Suppl . 1992;  10 S111-S114
    Google Scholar
  • 10 Takemura H, Kawasuji M, Sakakibara N. Quantitative hemodynamic assessment of internal mammary artery grafts using transthoracic duplex imaging.  Nippon Kyobu Geka Gakkai Zasshi . 1994;  42 2171-2177
    Google Scholar
  • 11 Van Son A J, Skotnicki S H, Peters M B. Noninvasive hemodynamic assessment of the internal mammary artery in myocadial revascularization.  Ann Thorac Surg . 1993;  55 404-409
    PubMedGoogle Scholar
  • 12 Fuda P, Pigatto A, De Gasperis C. Structural and morphometric analysis of the internal mammary artery used in coronary bypass surgery.  Minerva Cardioangiol . 1995;  43 21-27
    Google Scholar
  • 13 Folts J D, Gallagher K O, Kroncke G M. Myocardial revascularization of the canine circumflex coronary artery using retrograde internal mammary artery flow without cardiopulmonary bypass.  Ann Thorac Surg . 1981;  31 21-27
    PubMedGoogle Scholar
  • 14 Zheng W, Yuanzhong S, LiangHua Z. Experimental study of bypass surgery with retrograde flow of internal mammary artery anastomosed to right coronary artery.  Chin J Experimental Surg . 1987;  4 75-77
    PubMedGoogle Scholar
  • 15 Paletta C E, Vogler G, Freedman B. Viability of the rectus abdominis muscle following internal mammary artery ligation.  Plast Reconstr Surg . 1993;  92 234-238
    Google Scholar