The Feasibility of a Sensate Profunda Artery Perforator Flap in Autologous Breast Reconstruction: An Anatomic Study for Clinical Application.

BACKGROUND: The profunda artery perforator (PAP) flap has been demonstrated to be an effective method of autologous breast reconstruction, particularly when the abdominal donor site is contraindicated. However, there are no current reports regarding the use of a sensate PAP flap in this type of reconstruction. The objective of this study is to describe the feasibility and anatomic location of the sensory nerves supplying the PAP flap in relation to surface landmarks for use in autologous breast reconstruction. METHODS: In this anatomic study, 10 cadaver lower limbs were microsurgically dissected. We investigated the posterior femoral cutaneous nerve (PFCN), which supplies sensation to the skin of the posterior thigh and distribution of the PAP flap. The midline of the posterior thigh and gluteal crease were used for surface landmarks. The diameter and length of the nerve branches were documented. RESULTS: There were between 2 and 5 PFCN branches, with an average of 3 branches, that were found within the distribution of the PAP flap. Measurements were taken from the gluteal crease and midline to the nerve branches. The average distance caudal to the gluteal crease was 2.4 cm (0 to 7 cm). The average distance medial to the midline was 4.3 cm (0.2 to 8.1 cm). The average diameter of the nerve branches was 1.8 mm (1 to 2.5 mm). The average length of nerve branches from the flap to the fascia was 2.0 cm (1.5 to 2.4 cm). The maximum length of the nerve branches from the flap to the main trunk of the PFCN was 7.8 cm when tracing the nerve branches intramuscularly. CONCLUSIONS: The findings from this study provide an anatomic basis for the sensate PAP flap that would potentially provide an additional dimension to the use of this perforator flap in autologous breast reconstruction. These preliminary results are promising, and further physiological studies are warranted to validate the use of this sensate flap.

Vascular diameter determining the magnification for a microvascular anastomosis.

The purpose of this study was to determine the association between vascular diameters and amount of magnification and to assess the influence of the magnification media on the microanastomosis quality and permeability. Sixty arterial microanostomoses were distributed into three groups: group I (diameter 1.5 mm), group II (1.5 to 2.5 mm), and group III (> 2.5 mm). The models used were carotid artery of Sprague-Dawley rats and carotid and abdominal artery of wild rabbits. In each group, 10 anastomoses were performed with 2.5 x loupes and 10 with 10 x microscope. The total time of anastomosis, the quality of the anastomosis (Gorman scale), and 24-hour permeability rate were measured. The total anastomotic time and quality had statistical differences for the microscope by analyzing the total sample and group I only. The global permeability was 83% for the microscope and 40% for the loupe. The same result was observed in group I but no differences were observed in the other groups. The histology and the survey showed similar results. Microanastomoses performed under a microscope (10 x) were performed in less time, were of better quality, and had higher permeability rates when compared with those performed under a loupe (2.5 x). In vessels < 1.5 mm, these differences were statistically significant but in vessels > 1.5 mm no differences were observed.

Three-dose vs extended-course clindamycin prophylaxis for free-flap reconstruction of the head and neck.

BACKGROUND: Twenty-four hours of perioperative antibiotics provides effective prophylaxis for most head and neck cancer resections. Many reconstructive surgeons have been hesitant to apply this standard to free-flap reconstruction of the head and neck. This prospective clinical trial compared short-course and long-course clindamycin prophylaxis for wound infection in patients with head and neck cancer undergoing free-flap reconstruction. METHODS: Seventy-four patients were randomized to receive short-course (3 doses) or long-course (15 doses) clindamycin perioperatively. Wound infections, fistulas, and other postoperative complications were documented by faculty surgeons who were blinded as to treatment group. RESULTS: The differences in wound infections and other complications were statistically insignificant. No other independent predictors of wound complications emerged in this series of patients. CONCLUSIONS: Short-course clindamycin is as effective as long-course clindamycin in preventing wound infections after free-flap surgery for head and neck ablative defects.