Background: The authors analyzed arterial complications in patients undergoing breast reconstruction with superficial inferior epigastric artery (SIEA) flaps compared with deep inferior epigastric artery perforator (DIEP) flaps. The variability, caliber, and angiosome of the SIEA are cited as limitations. Experts currently limit SIEA reconstruction to cases with favorable arterial anatomy on preoperative imaging.
Methods: In this retrospective cohort study, consecutive flaps for breast reconstruction from the initial 7 years of a single microsurgeon's practice (2007 to 2013) were reviewed. Preoperative imaging was not used. Consistent intraoperative criteria for SIEA flap selection were used. All complications were abstracted independently in duplicate using a standardized form and a priori criteria.
Results: One hundred sixty-nine free flaps (SIEA, n = 44; DIEP, n = 125) were performed on 112 patients for unilateral or bilateral breast reconstruction. Significantly more SIEA flaps required reexploration versus DIEP flaps (20 percent versus 7 percent; p = 0.03). Arterial insufficiency was significantly higher among SIEA flaps (14 percent versus 1 percent; p = 0.001). There was no difference in venous insufficiency (p = 0.92). Significantly more SIEA flaps had necrosis requiring intervention (p = 0.03). Ultimately, significantly more SIEA flaps failed completely (14 percent versus 2 percent; p < 0.01). All SIEA flap failures were attributable to arterial thrombosis.
Conclusions: Compared with DIEP flaps, SIEA flaps had significantly higher proportions of reexploration, arterial complication, necrosis, and failure. No difference in venous complications was found. DIEP outcomes agree with existing literature from specialized centers. Complications and failures in SIEA flaps were attributed to arterial thrombosis. Given the authors' practice setting, SIEA flaps are no longer performed.
Clinical Question/level Of Evidence: Therapeutic, III.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/PRS.0000000000001150 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
"The Ultrathin Parascapular Flap: Proof of Concept and Use in Plantar Foot Reconstruction".
Plast Reconstr Surg
November 2024
Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, South Korea.
Optimal reconstruction of weight-bearing plantar foot defects is challenging due to the need for relatively thin coverage with simultaneous durability. The medial plantar flap provides an excellent tissue match but is not always available or appropriate (Figure 1, 2). Microsurgical free flap reconstruction provides many options for coverage.
View Article and Find Full Text PDFCoverage of large soft tissue defects of the lower limb and foot with superficial inferior epigastric artery flap.
Front Surg
October 2024
Department of Orthopaedics, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, Gansu, China.
Background: Large soft tissue defects of the lower limb and foot are common occurrence in clinical practice and a considerable number of flaps have been used to treat them. However, there have been few reports using the superficial inferior epigastric artery (SIEA) flap. This review aims to present the experience of using the SIEA flaps for the repair of large soft tissue defects of the lower limb and foot.
View Article and Find Full Text PDFThe Preferential Use of Subcutaneous Arteries (SCIA-SB and SIEA) in Abdominal-based Autologous Breast Reconstruction with a Modified Flap Design.
Plast Reconstr Surg Glob Open
October 2024
From the Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
Background: Despite its many advantages, the deep inferior epigastric artery perforator flap requires fascial incision and intramuscular dissection, which can lead to pain and weakening of the abdominal wall. The superficial inferior epigastric artery (SIEA) flap offers an alternative to avoid this damage but is often considered unreliable due to its variable anatomy. In this study, we report our experience in autologous breast reconstruction using either the superficial branch of the superficial circumflex iliac artery (SCIA-SB) or the SIEA as the sole flap pedicle.
View Article and Find Full Text PDFBreast reconstruction using the superficial circumflex iliac artery superficial branch perforator (SCISP) flap.
Plast Reconstr Surg
October 2024
Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital of St. John of God, Paracelsus Medical University, Kajetanerplatz 1, 5020 Salzburg, AUSTRIA.
Article Synopsis
- The deep inferior epigastric perforator (DIEP) flap is the standard method for breast reconstruction, but it can lead to complications like herniation and is time-consuming due to muscle dissection.
- The superficial circumflex iliac artery perforator flap has limited use in breast reconstructions compared to DIEP and SIEAflaps.
- A new technique called the superficial circumflex iliac artery superficial branch perforator (SCISP) flap offers a safer alternative by avoiding incision of the rectus fascia and successfully reconstructing breasts in patients with small to medium sizes.
Perforator Selection with Computed Tomography Angiography for Unilateral Breast Reconstruction: A Clinical Multicentre Analysis.
Medicina (Kaunas)
September 2024
Department of Plastic and Reconstructive Surgery, Peninsula Health, Melbourne 3199, Australia.
: Despite CTAs being critical for preoperative planning in autologous breast reconstruction, experienced plastic surgeons may have differing preferences for which side of the abdomen to use for unilateral breast reconstruction. Large language models (LLMs) have the potential to assist medical imaging interpretation. This study compares the perforator selection preferences of experienced plastic surgeons with four popular LLMs based on CTA images for breast reconstruction.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!