Martin Lhuaire1, Mikael Hivelin2, Moustapha Dramé3, Peter Abrahams4, Reza Kianmanesh5, Christian Fontaine6, Laurent Lantieri2. 1. Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris V, Paris, France; Institute of Anatomy and Organogenesis, Faculté de Médecine Henri Warembourg, Université de Lille II, Lille, France; Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France. Electronic address: martin.lhuaire@etudiant.univ-reims.fr. 2. Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris V, Paris, France. 3. Department of Research, Innovation and Biostatistics, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France. 4. Institute of Clinical Education, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom. 5. Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France. 6. Institute of Anatomy and Organogenesis, Faculté de Médecine Henri Warembourg, Université de Lille II, Lille, France.
Abstract
INTRODUCTION: The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate. This anatomical observational study aimed to determine whether anatomy could address this dilemma by determining the best vessel diameter to match the donor with these three recipient sites. METHODS: Our series reports 80 dissections of the three anatomical regions of interest. Forty formalin-preserved female cadavers were dissected bilaterally. Internal vessels diameter measurements were recorded with a vascular gauge ranging from 1.0 to 5.0 mm with successive half-millimeter graduations. RESULTS: The median diameter of the deep inferior epigastric (DIEA), internal thoracic (ITA), circumflex scapular (CSA), and thoracodorsal arteries (TDA) were: 2.0, 2.5, 2.5, and 1.5 mm, respectively. The median diameter of the deep inferior epigastric, internal thoracic, circumflex scapular, and thoracodorsal veins were: 3.0, 3.0, 3.0, and 2.5 mm, respectively. At the individual level, the perfect match between DIEA and ITA was significantly more frequent than between DIEA and TDA (p = 0.002), and it was more frequent between DIEA and CSA than between DIEA and TDA (p = 0.009). CONCLUSIONS: This study supports the use of the internal thoracic pedicle as the first recipient vessel choice, which should be considered, at least anatomically, as the best one with the closest diameter matching with the donor pedicle.
INTRODUCTION: The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate. This anatomical observational study aimed to determine whether anatomy could address this dilemma by determining the best vessel diameter to match the donor with these three recipient sites. METHODS: Our series reports 80 dissections of the three anatomical regions of interest. Forty formalin-preserved female cadavers were dissected bilaterally. Internal vessels diameter measurements were recorded with a vascular gauge ranging from 1.0 to 5.0 mm with successive half-millimeter graduations. RESULTS: The median diameter of the deep inferior epigastric (DIEA), internal thoracic (ITA), circumflex scapular (CSA), and thoracodorsal arteries (TDA) were: 2.0, 2.5, 2.5, and 1.5 mm, respectively. The median diameter of the deep inferior epigastric, internal thoracic, circumflex scapular, and thoracodorsal veins were: 3.0, 3.0, 3.0, and 2.5 mm, respectively. At the individual level, the perfect match between DIEA and ITA was significantly more frequent than between DIEA and TDA (p = 0.002), and it was more frequent between DIEA and CSA than between DIEA and TDA (p = 0.009). CONCLUSIONS: This study supports the use of the internal thoracic pedicle as the first recipient vessel choice, which should be considered, at least anatomically, as the best one with the closest diameter matching with the donor pedicle.
Authors: Martin Lhuaire; Karl Wehbe; Ignacio Garrido; Vincent Hunsinger; Mohamed Derder; Vincent Balaya; Vincent Delmas; Peter Abrahams; Daniele Sommacale; Reza Kianmanesh; Christian Fontaine; Laurent Lantieri Journal: Surg Radiol Anat Date: 2020-11-02 Impact factor: 1.246
Authors: Jun Hyeok Kim; Ye Sol Kim; Suk-Ho Moon; Young Joon Jun; Jong Won Rhie; Deuk Young Oh Journal: Biomed Res Int Date: 2020-07-16 Impact factor: 3.411
Authors: Artur Nixon Martins; João Nunes Pombo; Catarina Paias Gouveia; Bruno Gomes Rosa; Gaizka Ribeiro; Carlos Pinheiro Journal: Case Reports Plast Surg Hand Surg Date: 2022-03-10