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Marque M, Chartier R, Donette I, Assaf N, Dast S, Sinna R. [The tube in tube thoracodorsal perforator flap phalloplasty]. ANN CHIR PLAST ESTH 2023; 68:378-384. [PMID: 36801117 DOI: 10.1016/j.anplas.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 02/18/2023]
Abstract
This article deals with a clinical case of a tube in a tube TDAP phalloplasty in a 38 years old trans-man. While penis reconstruction surgery aroused an efflorescence of different operative techniques, the resulting female to male surgery sees these procedures boil down to two or three flaps. If we usually discuss before surgery about the way to lengthen the urinary tract, as the way to implant later for intercourse; the choice of the donor site remains too systematized. Surgeons commonly focus on the reconstructed site prior to the donor site. In this case, laxity in the back and reliability of direct closure make us harvest the thoracodorsal perforator flap. Dissection of perforators saves muscular function and direct closure afford an aesthetic result less visible than a graft on the forearm. The thin flap we harvest allows tube in tube phalloplasty so that phallus and urethra are being built in the same time. One case has been reported in the literature of thoracodorsal perforator flap phalloplasty with grafted urethra, but no case of tube within a tube TDAP phalloplasty.
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Affiliation(s)
- M Marque
- Service de chirurgie plastique reconstructrice et esthétique, CHU d'Amiens Picardie, Rond-point Pr Cabrol, 80054 Amiens cedex 1, France
| | - R Chartier
- Service de chirurgie plastique reconstructrice et esthétique, CHU d'Amiens Picardie, Rond-point Pr Cabrol, 80054 Amiens cedex 1, France
| | - I Donette
- Service de chirurgie plastique reconstructrice et esthétique, CHU d'Amiens Picardie, Rond-point Pr Cabrol, 80054 Amiens cedex 1, France
| | - N Assaf
- Service de chirurgie plastique reconstructrice et esthétique, CHU d'Amiens Picardie, Rond-point Pr Cabrol, 80054 Amiens cedex 1, France
| | - S Dast
- Service de chirurgie plastique reconstructrice et esthétique, CHU d'Amiens Picardie, Rond-point Pr Cabrol, 80054 Amiens cedex 1, France
| | - R Sinna
- Service de chirurgie plastique reconstructrice et esthétique, CHU d'Amiens Picardie, Rond-point Pr Cabrol, 80054 Amiens cedex 1, France.
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Zhang X, Mu D, Yang Y, Li W, Lin Y, Li H, Yao Y. The Value of BMI for Breast Reconstructions with the SIEA Flaps: Predicting the Ideal Intercostal Plane for the End-to-End Microvascular Anastomosis and the Possibility of Utilizing the TDA as a Salvage Recipient Choice. Aesthetic Plast Surg 2022; 46:2742-2752. [PMID: 35347379 DOI: 10.1007/s00266-022-02863-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND The superficial inferior epigastric artery (SIEA) diameter and the matching degree between the donor and the recipient arteries in terms of diameter are key factors affecting the outcome of the procedure in breast reconstructions with the SIEA flaps. A diameter of the SIEA ≥ 1.5 mm and a matching degree ≥ 1:2 (50%) of the diameters of the donor and the recipient arteries are recognized standards for the SIEA and the internal mammary artery (IMA) to achieve an end-to-end anastomosis. However, further refinements of the population characteristics and the ideal microscopic anastomosis intercostal planes are currently lacking for the criteria. METHODS In this study, based on 20 sides of hemiabdomen with computed tomography angiography (CTA) data suggesting the presence of the SIEA, we analysed the diameters of the donor and the recipient arteries as well as their matching degrees. The correlations between the parameters above and body mass index (BMI) were assessed. Based on the lower bounds of the 95% confidence intervals of the matching degrees and the two critical nodes of 50% and 67%, we theoretically evaluated the possibility of an end-to-end anastomosis of the SIEA and the IMA at different levels of BMIs and intercostal spaces, and predicted the possible intraoperative management measures for the SIEA. RESULTS The SIEA diameter, the thoracodorsal artery (TDA) diameter, and the diameters of the IMA at the 2nd to the 5th intercostal levels were positively correlated with the BMI (p < 0.05). A value of BMI ≥ 24 kg/m2 could indirectly reflect the application premise of the diameter of the SIEA ≥ 1.5 mm. The matching degrees of the SIEA with the TDA or the IMA at the 2nd to the 5th intercostal level were linearly and positively correlated with the BMI (p < 0.001). Based on the confidence interval analysis, we predicted different management techniques that might be needed intraoperatively for the SIEA at different BMI levels, when the SIEA and the IMA or the TDA were to be anastomosed in an end-to-end way. CONCLUSION For patients with preoperative CTA data suggesting the presence of the SIEA in the second-stage breast reconstructions, when a value of BMI ≥ 24 kg/m2 is met, the SIEA and the IMA can theoretically achieve an end-to-end anastomosis at the 3rd to the 5th intercostal level, and when 24 kg/m2 ≤ BMI ≤ 25 kg/m2, due to the large difference in diameters, the SIEA and the IMA at the 2nd intercostal level might need to adopt an end-to-side anastomosis or switch to the TDA recipient site. Based on this study's findings and aesthetic effect considerations, we think that the 3rd and the 4th intercostal planes are ideal choices for the end-to-end anastomosis. As a salvage recipient option, the TDA can theoretically achieve an end-to-end anastomosis with the SIEA at a value of BMI ≥ 24 g/m2. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Xiaoyu Zhang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Dali Mu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China.
| | - Yan Yang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Wandi Li
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Yan Lin
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Haoran Li
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
| | - Yu Yao
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, People's Republic of China
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Liu Y, Hou J, Zhu Z, Liu B, Cao M, Qin W. Assessment of breast arteries and lymph nodes by 3D MR angiography enhancement imaging: feasibility and pilot clinical results. BMC Med Imaging 2021; 21:97. [PMID: 34098896 PMCID: PMC8185933 DOI: 10.1186/s12880-021-00629-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background Conventional dynamic contrast enhanced (DCE) magnetic resonance (MR) hardly achieves a good imaging performance of arteries and lymph nodes in the breast area. Therefore, a new imaging method is needed for the assessment of breast arteries and lymph nodes. Methods We performed prospective research. The research included 52 patients aged from 25 to 64 between June 2019 and April 2020. The isotropic e-THRIVE sequence scanned in the coronal direction after DCE-THRIVE. Reconstructed images obtained by DCE-THRIVE and the coronal e-THRIVE were compared mainly in terms of the completeness of the lateral thoracic artery, thoracodorsal artery, and lymph nodes. We proposed a criterion for evaluating image quality. According to the criterion, images were assigned a score from 1 to 5 according to the grade from low to high. Two board-certified doctors evaluated images individually, and their average score was taken as the final result. The chi-square test was used to assess the difference. Results The coronal e-THRIVE score is 4.60, which is higher than the DCE-THRIVE score of 3.48, there are significant differences between the images obtained by two sequences (P = 1.2712e−8). According to the score of images, 44 patients (84.61%) had high-quality images on the bilateral breast. Only 3 patients’ (5.77%) images were not ideal on both sides. The improved method is effective for most patients to get better images. Conclusions The proposed coronal e-THRIVE scan can get higher quality reconstruction images than the conventional method to visualize the course of arteries and the distribution of lymph nodes in most patients, which will be helpful for the clinical follow-up treatment.
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Affiliation(s)
- Yang Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, People's Republic of China
| | - Jiaxin Hou
- Shenzhen Institute of Advanced Technology, Chinese Academy of Science, 1068 Xueyuan Avenue, Shenzhen, 518055, People's Republic of China
| | - Zhijun Zhu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, People's Republic of China
| | - Bingguang Liu
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, People's Republic of China
| | - Manrui Cao
- Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, People's Republic of China.
| | - Wenjian Qin
- Shenzhen Institute of Advanced Technology, Chinese Academy of Science, 1068 Xueyuan Avenue, Shenzhen, 518055, People's Republic of China.
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Kumar N, Aithal AP, Nayak SB, Bhaskar R. A rare case of atypical thoracodorsal artery: a challenge for flap reconstruction. Surg Radiol Anat 2018; 40:899-902. [PMID: 29594336 DOI: 10.1007/s00276-018-2009-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 03/26/2018] [Indexed: 11/30/2022]
Abstract
The thoracodorsal artery mainly supplies the latissimus dorsi muscle. Anatomical details pertaining to the origin and distribution of thoracodorsal artery are important because the latissimus dorsi myocutaneous flap is one of the most reliable and versatile flaps used in reconstructive surgery. Atypical origin and course of the thoracodorsal artery is, therefore, a challenge for flap reconstruction surgeries. In the present case, we report multiple variations in the branching pattern of axillary artery. The thoracodorsal artery had an unusual origin from the second part of axillary artery. The trunk of thoracoacromial artery was absent. The thoracodorsal artery after its origin, descended downwards over the lateral pectoral region lying deep to pectoralis minor but superficial to teres major muscles. It terminated by supplying the latissimus dorsi muscle. Due to the presence of atypical thoracodorsal branch, the subscapular artery continued as the circumflex scapular artery.
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Affiliation(s)
- Naveen Kumar
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, India
| | - Ashwini P Aithal
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, India.
| | - Satheesha B Nayak
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, India
| | - Ravi Bhaskar
- Department of Anatomy, Srinivas Institute of Medical Sciences and Research Center, Mukka, Mangalore, India
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Hashem T, Farahat A. Thoracodorsal artery perforator flap as an autologous alternative to acellular dermal matrix. World J Surg Oncol 2017; 15:185. [PMID: 29037204 PMCID: PMC5644174 DOI: 10.1186/s12957-017-1254-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/09/2017] [Indexed: 11/23/2022] Open
Abstract
Background Thoracodorsal artery perforator (TDAP) flap is one of the relatively new techniques in breast reconstruction. This pedicled flap retains the benefits of perforator flaps as regards minimal donor site morbidity without the need for microvascular anastomosis. Its role in partial breast reconstruction has been well documented. However, there are few reports about the role of this flap in total breast reconstruction. Methods This study included 47 cases who presented to the breast unit of the National Cancer Institute of Cairo University from 2013 to 2015. All patients underwent nipple-sparing mastectomy with immediate implant-based reconstruction. The TDAP flap was used to complete the subpectoral pocket for the implants in a way similar to the acellular dermal matrix. Results Overall complication rate was 14.9%. Capsular contracture occurred in 6.4%.There were no donor site complications. The majority of patients were satisfied with their cosmetic results. Sixty-eight percent rated their result as “excellent” or “good.” Conclusion Thoracodorsal artery perforator flap can play a significant role in total breast reconstruction. In settings with limited resources, this flap can serve as an available autologous alternative to acellular dermal matrix.
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Affiliation(s)
- Tarek Hashem
- Department of Breast Surgery, National Cancer Institute, Cairo University, Cairo, Egypt. .,Department of Surgical Oncology, National Cancer Institute, Nr 1.Fom el Khalig, Kasr el Aini str, Cairo, Egypt.
| | - Ahmed Farahat
- Department of Breast Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
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Wang X, He YJ, Li JF, Xie YT, Wang TF, Fan ZQ, Huo L, Ouyang T. [Breast-conserving surgery with immediate partial breast reconstruction using pedicled thoracodorsal artery perforator flap: a clinical analysis of 33 patients]. Zhonghua Wai Ke Za Zhi 2017; 55:120-125. [PMID: 28162211 DOI: 10.3760/cma.j.issn.0529-5815.2017.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the application value of pedicled thoracodorsal artery perforator flap in immediate partial breast reconstruction for breast cancer. Methods: This study is a prospective case series studies. Totally 128 cases of primary breast cancer patients who prepared to receive the breast-conserving surgery combine with immediate partial breast reconstruction of pedicled thoracodorsalartery perforator flap were enrolled in Breast Cancer Prevention and Treatment Center of Peking University Cancer Hospital from June 2013 to March 2016. Finally, the operations had been completed successfully in 33 eligible cases. All patients were female with a median age of 40 years (ranging from 22 to 52 years). The perforator vessel location, the donor area design, the post-operative complications, the influence of radiation and chemotherapy had been evaluated. Results: The average diameter of thoracic dorsal artery perforators measured by Doppler ultrasound before the operation was (1.5±0.4) mm (ranging from 0.6 to 2.7 mm). The average size of flaps was 15 cm×6 cm. The average time of operations was (271±72) minutes (ranging from 120 to 245 minutes). Drainage tube removed on (4.7±2.1) days after operation (ranging from 3 to 12 days). All patients received follow-up, and there was no local recurrence and distant metastasis during a median follow-up of 17(12) months (M(Q(R))) (ranging from 5 to 38 months). All TDAP flaps were survival, the wound complication rates was 6% (2/33). Conclusions: The breast reconstruction of pedicled thoracodorsal artery perforator flap is a good choice of repairing local breast defect of breast conserving surgery.Its advantages are no-influence of latissimus dorsi function and little complications in donor area.
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Affiliation(s)
- X Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Breast Cancer Prevention and Treatment Center, Peking University Cancer Hospital & Institute, Beijing 100143, China
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