ABSTRACT
Background: Autologous breast reconstruction is highly regarded in reconstructive surgery after mastectomy. DIEP flap reconstruction represents the gold standard for autologous breast reconstruction. The major advantages of DIEP flap reconstruction are its adequate volume, large vascular caliber and pedicle length. Despite reliable anatomy, there are procedures where the plastic surgeon's creativity is required, not only to shape the new breast, but also to overcome microsurgical challenges. An important tool in these cases is the superficial epigastric vein (SIEV). Methods: 150 DIEP flap procedures performed between 2018 and 2021 were retrospectively evaluated for SIEV use. Intraoperative and postoperative data were analyzed. Rate of anastomosis revision, total and partial flap loss, fat necrosis and donor site complications were evaluated. Results: In a total of 150 breast reconstructions with a DIEP flap performed in our clinic, the SIEV was used in 5 cases. The indication for using the SIEV was to improve the venous drainage of the flap or as a graft to reconstruct the main artery perforator. Among the 5 cases, no flap loss occurred. Conclusions: Use of the SIEV is an excellent method to expand the microsurgical options in breast reconstruction with DIEP flap surgery. It provides a safe and reliable procedure to improve venous outflow in cases of inadequate outflow from the deep venous system. The SIEV could also provide a very good option for fast and reliable application as an interposition device in case of arterial complications.
ABSTRACT
INTRODUCTION: Robotic-assisted surgery (RAS) has evolved over the past decades. Currently, novel robotic systems for microsurgery are being launched onto the European market. This novel microscope (RoboticScope®, BHS, Innsbruck, Austria) is a high-definition camera system, connected to an augmented reality headset, projecting a clear image with high magnification in front of the surgeon's eyes. Motion tracking translates the surgeon's head movements onto the system via a multi-axis robotic arm. We report the first use of the robotic microscope for autologous breast reconstruction in humans. METHODS: In May 2020, ten autologous breast reconstructions were performed by our Team. Five reconstructions (three PAP flaps, one bilateral DIEP flap) were conducted with the robotic microscope and matched to five reconstructions using a conventional microscope. We compared ischaemia times, times for arterial and venous anastomosis, and complications. RESULTS: All procedures were performed successfully and safely. Overall time for anastomosis was 31 min (+/- 7 min) in the robotic group and 25 min (+/- 7 min, p = 0.30) in the control group. Flap ischaemia was 54 min (+/- 8 min) in the robotic group and 52 min (+/- 22 min, p = 0.87) in the control group. No intraoperative complications such as venous thrombosis or arterial embolism occurred. CONCLUSION: Robotic microscopes provide the technology to combine flexibility to choose different angles during pedicle preparation and improve the stationary procedure of vessel anastomosis. Novel robotic systems tailored towards refinement in microsurgery hold great potential for implementation in Plastic Surgery procedures.
Subject(s)
Free Tissue Flaps , Mammaplasty , Robotic Surgical Procedures , Humans , Ischemia , Mammaplasty/methods , Microsurgery/methods , Retrospective StudiesABSTRACT
BACKGROUND: The superficial circumflex iliac artery perforator (SCIP) flap has been established in Asia to provide an excellent option for soft tissue defect coverage. The main advantage of this delicate flap is its very thin design. However, the adoption of this technique in other parts of the world has been rarely reported. METHODS: In this retrospective study, we analyzed outcomes of 32 SCIP flaps in a Caucasian patient population. The procedures were performed at our institution between March 2019 and August 2020. We present patient characteristics, surgical technique, perioperative care, and flap applications as compared to the Asian approaches. RESULTS: Patients' average BMI was 28.7. Flap anatomy and flap thickness at the superficial fascial plane differed significantly within our population. With 1.7 mm on average, the arterial diameter was higher than reported in the literature. Flaps were based on an axial perforator in 52% of cases. The SCIP flap was performed safely in the majority of cases. The surgical flap elevation approach was modified toward speedy perforator identification. CONCLUSIONS: The SCIP flap offers superior opportunities for thin soft tissue defect coverage with excellent functional outcomes in Caucasian patients. Based on higher BMI and anatomical differences as compared to Asian patient populations, modifications of flap elevation were necessary to increase reliability. More outcome reports from outside Asia need to become available to advance SCIP flap application internationally.
