Anglia Ruskin Research Online (ARRO)
Browse

File(s) under permanent embargo

Orienting the superficial inferior epigastric artery (SIEA) pedicle in a stacked SIEA-deep inferior epigastric perforator free flap configuration for unilateral tertiary breast reconstruction

journal contribution
posted on 2023-09-01, 14:41 authored by Ya-han Yu, Dina T. Ghorra, Christine Bojanic, Oti N. Aria, Louise MacLennan, Charles M. Malata
Superficial inferior epigastric artery (SIEA) flaps represent a useful option in autologous breast reconstruction. However, the short-fixed pedicle can limit flap inset options. We present a challenging flap inset successfully addressed by de-epithelialization, turnover, and counterintuitive rotation. A 47-year-old woman underwent left tertiary breast reconstruction with stacked free flaps using right deep inferior epigastric perforator and left SIEA vessels. Antegrade and retrograde anastomoses to the internal mammary (IM) vessels were preferred; additionally, the thoracodorsal vessels were unavailable due to previous latissimus dorsi breast reconstruction. Optimal shaping required repositioning of the lateral ends of the flaps superiorly, which would position the ipsilateral SIEA hemi-flap pedicle lateral to and out of reach of the IM vessels. This problem was overcome by turning the SIEA flap on its long axis, allowing the pedicle to sit medially with the lateral end of the flap positioned superiorly. The de-epithelialized SIEA flap dermis was in direct contact with the chest wall, enabling its fixation. This method of flap inset provides a valuable solution for medializing the SIEA pedicle while maintaining an aesthetically satisfactory orientation. This technique could be used in ipsilateral SIEA flap breast reconstructions that do not require a skin paddle, as with stacked flaps or following nipple-sparing mastectomy.

History

Refereed

  • Yes

Volume

47

Issue number

5

Page range

473-482

Publication title

Archives of Plastic Surgery

ISSN

2234-6171

Publisher

Korean Society of Plastic and Reconstructive Surgeons

File version

  • Accepted version

Language

  • eng

Legacy posted date

2020-05-27

Legacy creation date

2020-05-27

Legacy Faculty/School/Department

Faculty of Health, Education, Medicine & Social Care

Usage metrics

    ARU Outputs

    Categories

    No categories selected

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC