Figure 2 - uploaded by Yash Patil
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Photos show the dissected rectus abdominis muscle. On the left, the double DIEA is shown in situ, with the medial DIEA clamped. On the right, the harvested vertical rectus abdominis myocutaneous flap is shown, with the medial DIEA clamped (posterior view).
Source publication
The rectus abdominis flap offers a number of advantages over other flaps used in head and neck reconstruction. The flap can be harvested by a separate team and can be tailored to include skin, muscle, and fat. In addition, the available vascular pedicle is long and its large caliber provides an appropriate size match with recipient neck vessels. Ce...
Contexts in source publication
Context 1
... dissection of the VRAM flap, we observed that the deep inferior epigastric artery (DIEA) and vein were abnormally small in diameter (approximately 1.0 mm) and entered the rectus abdominis muscle close to its inferior insertion. Further dissection toward the pubic symphysis revealed a second, smaller pedicle along the medial border of the rectus abdominis muscle ( figure 2). The larger lateral pedicle was traced proximally to the external iliac vessels. ...
Context 2
... dissection of the VRAM flap, we observed that the deep inferior epigastric artery (DIEA) and vein were abnormally small in diameter (approximately 1.0 mm) and entered the rectus abdominis muscle close to its inferior insertion. Further dissection toward the pubic symphysis revealed a second, smaller pedicle along the medial border of the rectus abdominis muscle ( figure 2). The larger lateral pedicle was traced proximally to the external iliac vessels. ...
Similar publications
Background Bilateral microsurgical autologous reconstruction is known to increase operating time, costs, and complications compared to unilateral procedures. This study aimed to determine whether a unilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap and a unilateral deep inferior epigastric artery perforator (DIEP) free flap co...
Introduction: Abdominal region is a unique donor area in the reconstructive surgery to provide numerous flaps. The aim of this study is to show effectivity of the free vertical rectus abdominis muscle (VRAM) flap in the complex wounds reconstruction without damaging integrity of the rectus abdominis muscle and sacrificing the opposite deep inferior...
Background
The choice of the side of pedicled TRAM (transverse rectus abdominis myocutaneous flap) (whether ipsilateral or contralateral is not well established. Intra-operative direct visualization of the perforators of the deep inferior epigastric vessels on both sides facilitates the choice of the side of the flap but increases the operative tim...
Citations
... Alonso-Burgos et al. 6 demonstrated a single arterial anastomosis between a lateral DIEA and a lateral branch of the medial DIEA. Chung et al. 7 subsequently encountered two distinct DIEA systems during dissection for a vertical rectus abdominis myocutaneous (VRAM) flap. Each pedicle contained an abnormally small artery and paired vein, and flap non-viability was encountered 17 days post-operatively. ...
... In both instances the arteries were clearly visualized with preoperative CTA. 6,7 To our knowledge, this is the first reported case of a double DIEA that remains unobserved on CTA. With a sensitivity and positive predictive value for mapping musculocutaneous perforators of 99.6%, 8 CTA has become a frequent and reliable component of preoperative assessment. ...
Background:
Perforator flaps obtain the best results for the patient with the least morbidity, and should be considered the gold standard in head and neck reconstruction. Despite deep inferior epigastric perforator flap is considered the gold standard in breast reconstruction, its use in head and neck reconstructive surgery does not seem so widespread. The objective of this study was to conduct a systematic review of the use, applications and results of the DIEP flap in the head and neck area
Methods:
Search was conducted in different indexed databases (PubMed/MEDLINE, the Cochrane Library, Scielo and Web of Science) and the and through meta-searcher Trip Database with deep inferior epigastric perforator flap AND head neck keywords. Animal and human experimental published studies in peer-reviewed journals where investigators assessed the use of DIEP flap, according to the Koshima criteria, in the head and neck area were considered.
Results:
A total of 31 articles and 185 flaps with a 95% of survival were found. Thrombosis or venous stasis is the most frequent cause of flap loss and. A 16.1% presented some type of complication, the most frequent being the dehiscence. The most use was in the reconstruction of glossectomy defect secondary to squamous cell carcinoma (30.51%), being able potentially to re-establish sensory innervation in oral cavity. The assessment of risk bias (NIH) highlights the lack of uniformity, with no standardization of the outcome variables collection and monitoring.
Discussion:
Virtue of its versatility, reliable vascular supply, and high flap survival rate, the deep inferior epigastric perforator flap reconstruction could be an option in complicated 3-dimensional head and neck defects while maintaining the standard of low donor site morbidity.
