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Semin Plast Surg 2002; 16(1): 093-100
DOI: 10.1055/s-2002-22684
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Future of Supramicrosurgery as it Relates to Breast Reconstruction: Free Paraumbilical Perforator Adiposal Flap

Isao Koshima, Yuzaburo Nanba, Yoshio Takahashi, Akihiko Tsukino, Koji Kishimoto
  • Department of Plastic and Reconstructive Surgery, Okayama University Medical School, Okayama, Japan
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Publication History

Publication Date:
22 March 2002 (online)

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ABSTRACT

Pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps have been generally used for bilataral breast losses. The major disadvantages of this method are the total or subtotal loss of the rectus abdominis muscles and various resulting postoperative complications, such as abdominal bulging and lumbar pain. With the recent development of perforator flaps and supermicrosurgery with anastomosis of 0.5-mm caliber vessels, these serious complications can be overcome with a paraumbilical perforator adiposal flap with only perforators without the deep inferior epigastric artery and the rectus abdominis muscle. This article describes the successful use of paraumbilical adiposal flap for patients with breast loss and facial contour deformities without secondary debulking for recontouring. The advantages of this method are one-stage augmentation with minimal donor site morbidity resulting in minimum invasive surgery with minimum incision.

KEYWORD

Paraumbilical perforator flap - supermicrosurgery - pedicled rectus abdominis myocutaneous flap - deep inferior epigastric perforator flap

REFERENCES

  • 1 Koshima I, Inagawa K, Urushibara K. Paraumbilical perforator flap without deep inferior epigastric vessels.  Plast Reconstr Surg . 1998;  102 1052
    CrossrefPubMedGoogle Scholar
  • 2 Fujino T, Harashina T, Enomoto K. Primary breast reconstruction after a standard radical mastectomy by a free flap transfer.  Plast Reconstr Surg . 1976;  58 371
    Google Scholar
  • 3 Shaw W W. Breast reconstruction by superior gluteal microvascular free flaps without silicone implants.  Plast Reconstr Surg . 1983;  72 490
    Google Scholar
  • 4 Eliott L F, Beegle P H, Hartrampf C R. The lateral transverse thigh free flap: an alternative for autogenous-tissue breast reconstruction.  Plast Reconstr Surg . 1990;  85 169
    PubMedGoogle Scholar
  • 5 Robbins T H. Rectus abdominis myocutaneous flap for breast reconstruction.  Aust NZ J Surg . 1979;  49 527
    PubMedGoogle Scholar
  • 6 Hartrampf C R, Scheflan M, Black P W. Breast reconstruction with a transverse abdominal island flap.  Plast Reconstr Surg . 1982;  69 216
    CrossrefPubMedGoogle Scholar
  • 7 Holmstrom H. The free abdominoplasty flap and its use in breast reconstruction.  Scand J Plast Reconstr Surg . 1979;  13 423
    CrossrefPubMedGoogle Scholar
  • 8 Blondeel P hN, Boeckx W D, Vanderstraeten G G. The fate of the oblique abdominal muscle after free TRAM flap surgery.  Br J Plast Surg . 1997;  50 315
    CrossrefPubMedGoogle Scholar
  • 9 Blondeel N, Vanderstraeten G G, Monstrey S J. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.  Br J Plast Surg . 1997;  50 322
    Google Scholar
  • 10 Hamdi M, Weiler-Mithoff E M, Webster M HC. Deep inferior epigatric perforator flap in breast reconstruction: experience with the first 50 flaps.  Plast Reconstr Surg . 1999;  103 86
    CrossrefPubMedGoogle Scholar
  • 11 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle.  Br J Plast Surg . 1989;  42 645
    CrossrefPubMedGoogle Scholar
  • 12 Koshima I, Moriguchi T, Fukuda H. Free, thinned, paraumbilical perforator-based flaps.  Reconstr Microsurg . 1991;  7 313
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Koshima I, Moriguchi T, Soeda S. Free thin paraumbilical perforator-based flaps.  Ann Plast Surg . 1992;  29 12
    CrossrefPubMedGoogle Scholar
  • 14 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg . 1994;  32 32
    Google Scholar
  • 15 Blondeel P hN, Boeckx W D. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery.  Br J Plast Surg . 1994;  47 495
    Google Scholar
  • 16 Fujino T, Tanino R, Sugimoto C. Microvascular transfer of free deltopectoral dermal-fat flap.  Plast Reconstr Surg . 1975;  55 428
    PubMedGoogle Scholar
  • 17 Shintomi Y, Ohura T, Honda K, Iida K. The reconstruction of progressive facial hemi-atrophy by free vascularized dermis-fat flaps.  Br J Plast Surg . 1981;  34 398-409
    CrossrefPubMedGoogle Scholar
  • 18 Harashina T, Nakajima T, Yoshimura Y. A free groin flap reconstruction in progressive facial hemiatrophy.  Br J Plast Surg . 1977;  30 14-16
    CrossrefPubMedGoogle Scholar
  • 19 Dunkley M P, Stevenson J H. Experience with the free ``inverted'' groin flap in facial soft tissue contouring; a report on 6 flaps.  Br J Plast Surg . 1990;  43 154-158
    CrossrefPubMedGoogle Scholar
  • 20 Inigo F, Rojo P, Ysunza A. Aesthetic treatment of Romberg's disease: experience with 35 cases.  Br J Plast Surg . 1993;  46 194-200
    CrossrefPubMedGoogle Scholar
  • 21 Stern H S, Elliott L F, Beegle P H. Progressive hemifacial atrophy associated with Lyme disease.  Plast Reconstr Surg . 1992;  90 579-483
    PubMedGoogle Scholar
  • 22 Upton J, Albin R E, Mulliken J B, Murray J E. The use of scapular and parascapular flaps for cheek reconstruction.  Plast Reconstr Surg . 1992;  90 959-971
    CrossrefPubMedGoogle Scholar
  • 23 Longaker M T, Siebert J W. Microvascular free-flap correction of severe hemifacial atrophy.  Plast Reconstr Surg . 1995;  96 800-809
    CrossrefPubMedGoogle Scholar
  • 24 Siebert J W, Anson G, Longaker M T. Microsurgical correction of facial assymmetry in 60 consecutive cases.  Plast Reconstr Surg . 1996;  97 354-363
    CrossrefPubMedGoogle Scholar
  • 25 Longaker M T, Siebert J W. Microsurgical correction of facial contour in congenital craniofacial malformations: the marriage of hard and soft tissue.  Plast Reconstr Surg . 1996;  98 942-950
    CrossrefPubMedGoogle Scholar
  • 26 Longaker M T, Flynn A, Siebert J W. Microsurgical correction of bilateral facial contour deformities.  Plast Reconstr Surg . 1996;  98 951-957
    CrossrefPubMedGoogle Scholar