The primary purpose of this article is to evaluate the feasibility and outcomes of the dcia terminal musculocutaneous perforator flap with iliac crest i. A licence package is needed for accessing this content. A lifttheflap book by rod campbell, where is babys belly button. The first patient was a 52yearold woman who had undergone previous attempts at breast reconstruction with a failed transverse rectus abdominis muscle tram flap and a failed implant. Basics of microvascular reconstruction of maxillomandibular.
The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. It shows the surgical dissection techniques of each flap step by step, from vascular anatomy, flap design and elevation to harvest and transfer. All women who undergo mastectomy are candidates for consideration of perforator flap breast reconstruction when natural tissue reconstruction is preferred over implant reconstruction. A doppler ultrasound can be used preoperatively to identify arterial signals on the skin flap. A dcia free flap is one way of filling a bony hole in either the upper or lower jaw. Key topics in oral and maxillofacial surgery by mostafa. Preexpanded perforator flaps, an issue of clinics in plastic surgery authors. Breast reconstruction with flap surgery is a complex procedure performed by a plastic surgeon. Thousands rss medical sources are combined and output via different filters.
Register for trial choose your licence package for full free access during a 14day test period. We are very pleased to announce the penn flap course to be held on august 1416, 2020. In a diep flap, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. We used a doppler to find several perforator candidates. This book is an essential authoritative guide for plastic surgeons interested in making perforator flap reconstruction part of their practice. However, not all perforators originate from the terminal end of dcia. Penn annual flap dissection course penn flap course fresh.
India viva books private limited 43253 ansari road, daryaganj new delhi 12. This has also caused a corresponding increase in the number of breast. We use cookies on our website, only to provide you with a better service. A cost based comparison between perforator flaps and tram. The pap flap is an alternative to abdominal based donor sites for autologous breast reconstruction in patients where the abdomen is undesirable or contraindicated.
The dcia may take origin from the external iliac artery alone, or with a common trunk that provides both the dcia and the scia. Dciadeep circumflex iliac artery flap british association. Deep circumflex iliac artery dcia osteocutaneous flap transfer was frequently applied to large defects in the. The purpose of this article is to present our approach to the reconstruction of head and neck defects using the superficial circumflex iliac artery perforator scip flap with the aid of preoperative computed tomography angiography cta mapping. Methods the deep circumflex iliac artery perforator flap dcia flap and intercostal artery perforator flap ica flap were performed n 12. This feed contains the latest items from the clinical anatomy source. Deep circumflex iliac artery perforator flap with iliac crest. The management of patients with hand and upperlimb deficiencies is a routine task in reconstructive surgery. It is one of the common ways of replacing bone that has been removed for cancer treatment. The dcia perforator will exit the anterior abdominal wall superior and lateral to the asis. Plastic surgery perforator flaps thieme medical publishers. Shih specializes in breast recontruction diep flaps and aesthetic surgery.
The anterolateral thigh flap is the most commonly used perforator flap in head and neck reconstruction. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces. If there is a potential to harvest multiple perforator flaps from one vessel, the name of each flap should be based on its anatomical region or muscle. Perforator based propeller flaps in limb reconstructive. Download as an information leaflet pdf oral mouth biopsy. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb, and the trunk.
The artery supplying blood to the bone is called the deep. Pdf anatomical consideration for the safe elevation of the deep. A cost based comparison between perforator flaps and tram flaps for breast reconstruction may 2000 robert j. The flaps were used for head and neck reconstruction n, upper extremity reconstruction n 19, lower limb reconstruction n 176. The flap can be harvested with or without a skin paddle.
Pdf perforator flaps in head and neck reconstruction. The deep circumflex iliac artery dcia flap is often used for mandibular reconstruction but it is bulky and causes additional donorsite morbidity because of the inclusion of an obligatory internal oblique muscle. A 51yearold female with a history of left breast dcis, bilateral mastectomy and pedicled transverse. Its use is described in detail, as is use of other less common perforator flaps. Feb 28, 2019 overall, only 1516% of these mastectomy patients undergo reconstruction. When the dcia was transected, the gluteal perforators were dilated bilaterally. Freeflap breast reconstruction is a type of autologoustissue breast reconstruction applied after. Pelvic bone the flap is removed along with two blood vessels, one of which supplies blood to the flap the artery and one of which drains blood from it the vein. Only the pedicle was different between the two flaps. Course material will include a program book with dissection guides and. A biopsy is a procedure where a small piece of tissue is removed from an area so that it can be looked at closely under a microscope.
The deep circumflex iliac artery dcia osteomusculocutaneous flap with iliac crest has been one of the most useful flaps used for mandibular reconstruction. The propeller flap represents a model of local perforator flap that was first described by hyakusoku et al. The plastic surgeons of the new york breast reconstruction associates at aesthetic plastic surgery, pc, perform hundreds of microsurgical free flap breast reconstruction operations every year. The parasacral perforator flap is a reliable flap that preserves the entire contralateral side as a future donor site. A perforator flap is a flap consisting of skin and subcutaneous tissue that is perfused by an isolated. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters. We present the case of a 76yearold woman treated with an osteomyocutaneous dciap flap variant for facial reconstruction. Sam shih founded plastic and reconstructive surgery of atlanta with the vision of providing to best care to patients facing cancer or following traumatic injury. Breast reconstruction with flap surgery mayo clinic. University of groningen the significance of preoperative.
Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. Freestyle local perforator flaps for facial reconstruction. We then designed a propeller perforator flap around the possible perforators to be used. Fibula osteocutaneous free flap dissection video duration. A perforator flap should be named after the nutrient artery or vessels and not after the underlying muscle.
A diep flap is considered a musclesparing type of flap. In this model the flap is harvested around a cutaneous perforator arterial branch by twisting of the vascular pedicle and rotating the skin paddle. Malizos re constructive microsurgerylandes bio science vademecum free ebook download as pdf file. Neil cahoon, md, josh gillis, md, and rotana fageeh, md. Preexpanded perforator flaps, an issue of clinics in plastic. We then incised through skin and subcutaneous tissue with the knife using electrocautery. Between january of 2011 and january of 2014, 210 superficial circumflex iliac artery perforator flaps were performed at asan medical center. The anatomical basis of the deep circumflex iliac artery perforator. Despite advances in reconstruction techniques, pressure sores continue to present a challenge to the plastic surgeon.
Discover everything scribd has to offer, including books and audiobooks from major publishers. Malizos re constructive microsurgerylandes bio science. In our experience, the icg studies have shown that the dcia perforator reliably perfuses the skin for 15 cm medial, lateral, and superior to the perforator entry point into the flap. Since the concept of freestyle free flaps was first presented, many new types of flap, including the superficial circumflex iliac artery perforator scip flap, have been reported. The dcia flap is folded on top of the diep flap, creating a stacked flap with the dcia superficial and the diep deep. The deep circumflex iliac artery perforator flap dciapa. The deep circumflex iliac artery perforator flap for breast. Florian ensat and lorenz larcher, booktitleeuropean surgery, year2015. The pap flap for breast reconstruction was originated in 2010 by dr.
The medial sural artery perforator flap is a good alternative for head and neck reconstruction, with the advantages of thin and pliable skin, a long and reliable vascular pedicle, straightforward. Allen at the th international course on perforator flaps in mexico city. The first ever international course on perforator flaps icpf was organized in gent, belgium, 20 years ago in 1997, when perforator flap surgery was still in its pioneering phase. Facial reconstruction with a unique osteomyocutaneous dcia. Groin flap and superficial circumflex iliac artery. Diepsiea flap breast reconstruction aesthetic plastic. The percentage of surviving flap area was measured after 7 days with digital. Idc n31 or ductal carcinoma in situ dcis n2 on histopathology. We then performed a spy angiography and found 1 or 2 areas which confirmed our suspected doppler locations. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites.
Flaps in hand and upper limb reconstruction por allen t. The combined deep inferior epigastric perforator diepdcia flap is most commonly used when the diep flap would provide inadequate. Parasacral perforator flaps for reconstruction of sacral. The skin paddle can make the flap quite thick however, often making inset difficult.
Superficial circumflex iliac artery perforator flap. Keystone and pedicle perforator flaps in reconstructive. Initial descriptions of perforator flaps in 1989 by koshima and soeda, by using a musculocutaneous flap with an inferior epigastric arterybased skin island for reconstruction of defects involving the floor of mouth and groin, have led to significant additional advancements in the understanding of perforator flaps and vascular anatomy. Objective and quantifiable measuring mechanism for. Program thursday, august 24, 2017 cadaver labs cadaver lab dissection the ohio state university hamilton hall room 256258 columbus, oh 43210 shuttle service provided from grand event center to ha. The flap is marked lateral and medial to the perforator with more of the extension laterally.
This comprehensive video library includes 29 perforator and axial pattern skin flap dissections in the head and neck, trunk, and upper and lower extremity. Much of the breast reconstruction using your bodys own tissue can be accomplished at the time of your mastectomy immediate reconstruction, though sometimes it can be done as a separate procedure later delayed reconstruction. The usefulness of pedicled perforator flap in partial breast. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires. Unlike the dieap flap the siea flap is not a perforator flap, because the vessels do not. Pu and chunmei wang, is devoted to preexpanded perforator flaps. Bipedicleconjoined perforator flaps in breast reconstruction.
If the dcia perforator is injured during dissection, the lateral flank tissue can be harvested based on the superficial circumflex iliac artery or an intercostal. The dcia flap relies on inflow from the vessels originating near the junction of the external iliac artery and the femoral artery at the inguinal ligament. Intercostal artery perforator flap oncoplastic breast. Large composite segmental mandibular resections that consist of floor of mouth, subtotal tongue. It has been championed as an alternative to the tug flap. This low percentage has been attributed to lack of both information and access. Profunda artery perforator pap flap for breast reconstruction.
Perforator flaps for breast reconstruction kindle edition by joshua. We prefer a second flap, such as the groin flap, which can be harvested in the same field, often with the same vascular trunk to the groin flap and the dcia flap. The flap markings are tapered to a point just medial to the linea semilunaris anteriorly and to the midgluteal line posteriorly. The scia perforator exits around the medial aspect of the anterior superior iliac spine. A multitude of conventional and microvascular read more. The deep circumflex iliac artery perforator flap for. Pdf perineal and posterior vaginal wall reconstruction with. Although greater success was achieved with the dcia pedicle flap after the landmark report by taylor and townsend in 1979, detailing the dcia as the main blood supply to the iliac crest, a lack of familiarity with the dcia perforators in these early studies limited the use of the dcia flap as a composite flap.