Add-On Extended Dorsal Intercostal Artery Perforator Propellar Flap (AOE-DICAP) For The Reconstruction Of Large Posterior Trunk Defects

Introduction Reconstruction of large posterior trunk soft tissue defects poses a challenging problem. Until recently, these defects were reconstructed with multiple random pattern flaps, local pedicled muscle flaps and musculocutaneous flaps.The posterior intercostal arteries form the major angiosome of the trunk through multiple perforators to the skin.Some studies in the recent literature have highlighted the reliability of the classical DICAP flap in the posterior trunk reconstruction. Aim: To determine the efficacy, reliability and clinical outcomes of the add-on extended dorsal intercostal artery perforator propeller flaps (AOE-DICAP)for the reconstruction of large posterior trunk defects. Materials & Methods: Six patients (3 infants and 3 adults) with posterior trunk defects due to variousaetiologies were reconstructed with AOE-DICAP flap. Result: All flaps survived completely, except for superficial epidermolysis at the distal border of the flap in one patient that healed secondarily. Average follow up was 12 months. Conclusion: Add-on extended DICAP (AOE-DICAP) flap provides an excellent stable cover and a viable option for large median and para-median back defects reconstruction.

Surgery for giant tumours of the breast: a 15 year review

Background: Giant tumours of the breast tend to occur in the adolescent age group. Racial predilection has been noted in the literature. The mass often occupies most of the breast, leading to its distortion. Many authors have advocated a mastectomy for benign tumours that severely distort the breast. Giant benign tumours when treated by simple excision risk persistence of asymmetry. To avoid this asymmetry, some authors have resorted to excision and immediate reduction mammaplasty. The aim of this retrospective study was a report on giant tumours of the breast presenting to a plastic surgery unit and to analyse demographic factors, clinical presentations, tumour pathology, management, complications, as well as patient and breast outcomes.Methods: Medical records of patients with giant tumours were retrospectively analysed for assessing demographic factors, clinical presentation, tumour pathology, the technique of surgery performed and patient and breast outcomes in a single hospital setting. Breast outcomes were rated by panel of 4 experienced plastic surgeons using the 4 Point Likert scale. Their ratings were statistically analysed for inter-rater agreement.Results: Twenty-three subjects were identified to have giant tumours of the breast. Of these South African patients, 19 were black, 3 were Indian and 1 was of mixed ethnicity. The age range was 12­49 years(y) with an average of 19y. All masses were palpable. The final pathological diagnosis was fibrocystic disease in 3, giant fibroadenoma in 14, phyllodes tumour in 4, and hamartoma in 2. The size range was 10­45 cm with a median size of 18 cm. All but one patient had simple excision followed by immediate reduction mammaplasty. Twenty patients were assessed after operation. A minimum of 1 to a maximum of 4 patients per reviewer showed unsatisfactory outcomes and a minimum of 18 to a maximum of 21patients per reviewer showed satisfactory to excellent outcomes. The overall agreement between assessors for this was 84%. Conclusion: Benign giant tumours (> 10 cm) of the breast are suitably managed by excision of the mass and a reduction mammoplasty technique of reconstruction