Autologous mastectomy reconstruction: Communication among the breast surgery team to maximize aesthetic and oncologic outcome.

Mastectomy breast reconstruction with autologous tissue is challenging. Oncologic and aesthetic goals face previous surgical scars, radiation, chemotherapy, or other comorbidities. We describe a simple approach for autologous mastectomy reconstruction so that breast and plastic and reconstructive surgeons can maximize aesthetic outcomes and minimize wound complications.

Acellular dermal matrix for temporary coverage of exposed critical neurovascular structures in extremity wounds.

Introduction: Large-volume soft-tissue defects often leave exposed neurovascular and vital structures not amenable to immediate flap coverage. We describe the use of AlloDerm, an acellular dermis allograft, in providing temporary coverage of these structures in multistage reconstruction of the extremity.

Methods: A prospective study of 25 patients was performed using AlloDerm for temporary coverage of exposed vital structures secondary to trauma and oncologic ablation.

Is the use of intraoperative heparin safe?

Background: Despite the reliability of microvascular free tissue transfer, flap loss remains a significant concern. To improve outcome, various pharmacologic agents have been used to prevent microvascular thrombosis. The authors review their experience with intraoperative heparin therapy, specifically addressing the risks of hematoma, pedicle thrombosis, and flap loss rate.

Salvage of congested deep inferior epigastric perforator flap with a reverse flow venous anastomosis.

The deep inferior epigastric perforator flap (DIEP) is an increasingly popular method for autologous breast reconstruction because of less abdominal wall donor-site morbidity. However, disadvantages with the DIEP flap are its greater technical difficulties for flap harvest and a greater incidence of venous congestion. We report a case of salvage of a congested DIEP flap with a superficial inferior epigastric vein (SIEV) to deep inferior epigastric vein reverse flow anastomosis.

The effect of postoperative anticoagulation on microvascular thrombosis.

Background: Numerous protocols exist to prevent thrombosis after free-tissue transfer. Many surgeons advocate using aspirin or other antiplatelet agents, but little objective evidence supports this practice. This study evaluates the rate of microvascular thrombosis in patients undergoing free-tissue transfer treated with or without antiplatelet agents.