The Gracilis Myocutaneous Free Flap: A Quantitative Analysis of the Fasciocutaneous Blood Supply and Implications for Autologous Breast Reconstruction
| Autor: | Ramin Shayan, Iain S. Whitaker, Mark W. Ashton, Warren M. Rozen, Cara Michelle le Roux, Maria Karavias, Russell J Corlett, G. Ian Taylor |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Anatomy and Physiology Science Mammaplasty medicine.medical_treatment Radiography Dermatologic Surgical Procedures Skin Anatomy Free flap Magnetic resonance angiography medicine Humans Gracilis muscle Comparative Anatomy Muscle Skeletal Biology Musculoskeletal System Aged Skin Aged 80 and over Multidisciplinary medicine.diagnostic_test business.industry Anatomy Middle Aged Reconstructive Surgery Surgery Dissection Surgical Oncology Angiography Medicine Muscle Female business Breast reconstruction Magnetic Resonance Angiography Research Article |
| Zdroj: | PLoS ONE PLoS ONE, Vol 7, Iss 5, p e36367 (2012) |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0036367 |
| Popis: | BackgroundMastectomies are one of the most common surgical procedures in women of the developed world. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. This study quantifies the fasciocutaneous vascular territories of the gracilis flap and offers the potential to reconstruct breasts of all sizes.MethodsTwenty-seven human cadaver dissections were performed and injected using lead oxide into the gracilis vascular pedicles, followed by radiographic studies to identify the muscular and fasciocutaneous perforator patterns. The vascular territories and choke zones were characterized quantitatively using the 'Lymphatic Vessel Analysis Protocol' (LVAP) plug-in for Image J® software.ResultsWe found a step-wise decrease in the average vessel density from the upper to middle and lower thirds of both the gracilis muscle and the overlying skin paddle with a significantly higher average vessel density in the skin compared to the muscle. The average vessel width was greater in the muscle. Distal to the main pedicle, there were either one (7/27 cases), two (14/27 cases) or three (6/27 cases) minor pedicles. The gracilis angiosome was T-shaped and the maximum cutaneous vascular territory for the main and first minor pedicle was 35 × 19 cm and 34 × 10 cm, respectively.ConclusionOur findings support the concept that small volume breast reconstructions can be performed on suitable patients, based on septocutaneous perforators from the minor pedicle without the need to harvest any muscle, further reducing donor site morbidity. For large reconstructions, if a 'T' or tri-lobed flap with an extended vertical component is needed, it is important to establish if three territories are present. Flap reliability and size may be optimized following computed tomographic angiography and surgical delay. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|