Perforator Flap Breast Reconstruction Workup

  • Author: Frank J DellaCroce, MD; Chief Editor: James Neal Long, MD, FACS   more...
 
Updated: Aug 3, 2011
 

Laboratory Studies

Basic presurgical laboratory studies include blood counts and chemistries. ECGs and chest x-rays are obtained according to pre-anesthesia guidelines.

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Imaging Studies

Color-flow Doppler and CT angiography have been used for imaging of blood flow patterns in various perforator flaps. They may be of use when the integrity or pattern of blood flow within the flap is in question.[5, 6] However, these modalities are not typically employed in routine clinical practice.

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Contributor Information and Disclosures
Author

Frank J DellaCroce, MD  Co-Director, Center for Restorative Breast Surgery; Clinical Instructor, Department of Surgery, Division of Plastic and Reconstructive Surgery, Tulane University and Louisiana State University School of Medicine in New Orleans

Frank J DellaCroce, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society for Reconstructive Microsurgery, American Society of Plastic Surgeons, Harris County Medical Society, Louisiana State Medical Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Scott K Sullivan, MD, FACS  Co-Director, Center for Restorative Breast Surgery

Scott K Sullivan, MD, FACS is a member of the following medical societies: American Society for Reconstructive Microsurgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Pankaj Tiwari, MD  Assistant Professor, Division of Plastic Surgery, Ohio State University College of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

R Edward Newsome†, MD  Former Program Director and Chief of Plastic Surgery, Henderson Chair in Surgery, Former Assistant Dean for Graduate Medical Education, Tulane University School of Medicine

R Edward Newsome†, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic and Reconstructive Surgery, American Society of Plastic Surgeons, and Louisiana State Medical Society

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

James Neal Long, MD, FACS  Associate Professor of Plastic and Reconstructive Surgery, Division of Plastic Surgery, Children's Hospital and Kirklin Clinics, University of Alabama at Birmingham School of Medicine; Chief of Plastic, Reconstructive, Hand, and Microsurgery, Birmingham Veterans Affairs Medical Center

James Neal Long, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Plastic Surgery Research Council, Sigma Xi, Southeastern Society of Plastic and Reconstructive Surgeons, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.

References

  1. Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg. Feb 1982;69(2):216-25. [Medline].

  2. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg. Nov 1989;42(6):645-8. [Medline].

  3. Koshima I, Moriguchi T, Soeda S, et al. The gluteal perforator-based flap for repair of sacral pressure sores. Plast Reconstr Surg. Apr 1993;91(4):678-83. [Medline].

  4. Gill PS, Hunt JP, Guerra AB, et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg. Apr 1 2004;113(4):1153-60. [Medline].

  5. Rozen WM, Phillips TJ, Ashton MW, Stella DL, Gibson RN, Taylor GI. Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast Reconstr Surg. Jan 2008;121(1):9-16. [Medline].

  6. Rozen WM, Palmer KP, Suami H, et al. The DIEA branching pattern and its relationship to perforators: the importance of preoperative computed tomographic angiography for DIEA perforator flaps. Plast Reconstr Surg. Feb 2008;121(2):367-73. [Medline].

  7. Bottero L, Lefaucheur JP, Fadhul S, Raulo Y, Collins ED, Lantieri L. Electromyographic assessment of rectus abdominis muscle function after deep inferior epigastric perforator flap surgery. Plast Reconstr Surg. Jan 2004;113(1):156-61. [Medline].

  8. Craigie JE, Allen RJ, DellaCroce FJ, Sullivan SK. Autogenous breast reconstruction with the deep inferior epigastric perforator flap. Clin Plast Surg. Jul 2003;30(3):359-69. [Medline].

  9. Blondeel N, Vanderstraeten GG, Monstrey SJ, et al. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction. Br J Plast Surg. Jul 1997;50(5):322-30. [Medline].

  10. Futter CM, Webster MH, Hagen S, Mitchell SL. A retrospective comparison of abdominal muscle strength following breast reconstruction with a free TRAM or DIEP flap. Br J Plast Surg. Oct 2000;53(7):578-83. [Medline].

  11. Fujino T, Harasina 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. Aug 1975;56(2):178-81. [Medline].

  12. DellaCroce F, Sullivan S. Chimeric Stacked Deep Inferior Epigastric Perforator Flap Breast Reconstruction: A New Solution to an Old Problem. J Recon Microsurg. 2007;23:418.

  13. DellaCroce FJ, Sullivan SK, Trahan C. Stacked deep inferior epigastric perforator flap breast reconstruction: a review of 110 flaps in 55 cases over 3 years. Plast Reconstr Surg. Mar 2011;127(3):1093-9. [Medline].

  14. Hamdi M, Spano A, Van Landuyt K, D'Herde K, Blondeel P, Monstrey S. The lateral intercostal artery perforators: anatomical study and clinical application in breast surgery. Plast Reconstr Surg. Feb 2008;121(2):389-96. [Medline].

  15. Chen CM, Halvorson EG, Disa JJ, et al. Immediate postoperative complications in DIEP versus free/muscle-sparing TRAM flaps. Plast Reconstr Surg. Nov 2007;120(6):1477-82. [Medline].

  16. Allen RJ, Dupin CL, DellaCroce FJ. Perforator flaps in breast reconstruction. Perspectives in Plastic Surgery. 2000;14:37-54.

  17. Celik N. Anteriolateral thigh flap for postmastectomy breast reconstruction. Seminars in Plastic Surgery. 2002;16:45-52.

  18. DellaCroce FJ. Deep inferior epigastric perforator flap breast reconstruction. Seminars in Plastic Surgery. 2002;16: 7-17.

  19. DellaCroce FJ, Sullivan SK. Application and refinement of the superior gluteal artery perforator free flap for bilateral simultaneous breast reconstruction. Plast Reconstr Surg. Jul 2005;116(1):97-103; discussion 104-5. [Medline].

  20. Fujino T, Harashina T, Enomoto K. Primary breast reconstruction after a standard radical mastectomy by a free flap transfer. Case report. Plast Reconstr Surg. Sep 1976;58(3):371-4. [Medline].

  21. Holmstrom H, Lossing C. The lateral thoracodorsal flap in breast reconstruction. Plast Reconstr Surg. Jun 1986;77(6):933-43. [Medline].

  22. Wei FC, Suominen S, Cheng MH, Celik N, Lai YL. Anterolateral thigh flap for postmastectomy breast reconstruction. Plast Reconstr Surg. Jul 2002;110(1):82-8. [Medline].

 
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Presurgical markings with location of deep inferior epigastric perforator (DIEP) and superficial inferior epigastric artery (SIEA) signal points depicted (as determined by Doppler ultrasonography).
Superficial inferior epigastric vessels dissected out.
Presurgical superior gluteal artery perforator (SGAP) flap donor-site markings with location of SGAP signal points depicted on left (as determined by Doppler ultrasonography). Postsurgical donor site appearance clothed on right.
Perforating branches of deep inferior epigastric system dissected out.
Before and after right skin-sparing mastectomy for invasive ductal carcinoma with immediate deep inferior epigastric perforator (DIEP) flap reconstruction and left mastopexy.
Before and after bilateral prophylactic skin-sparing mastectomy with immediate deep inferior epigastric perforator (DIEP) flap reconstruction in a patient positive for the BRCA gene.
Before and after bilateral mastectomy for ductal carcinoma in situ (DCIS) with immediate deep inferior epigastric perforator (DIEP) flap reconstruction.
Before and after reconstruction of defect resulting from right lumpectomy and radiation with superior inferior epigastric artery (SIEA) flap and left mastopexy for symmetry.
Before and after delayed bilateral reconstruction with superior gluteal artery perforator (SGAP) flaps.
Before and after superior gluteal artery perforator (SGAP) flap donor site (same patient as in previous image).
Implant reconstruction with painful capsular contracture (left) and after implant removal with superior gluteal artery perforator (SGAP) flap reconstruction bilateral (right).
Before and after superior gluteal artery perforator (SGAP) flap donor site (same patient as in previous image).
Before and after delayed bilateral reconstruction with superior gluteal artery perforator (SGAP) flaps. Abdominal scar results from abdominoplasty performed at second stage surgery.
Before and after superior gluteal artery perforator (SGAP) flap donor site (same patient as in previous image).
Stacked DIEP flap.
Lumbar perforator dissected out.
 
 
 
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