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Source
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| Surgery
of The Breast
Principals and Art
Volume: n/a
Number: n/a
1999 |
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Index
The Deep Inferior Epigastric
Perforator Flap
The Gluteal Artery Perforator
Flap
The Thoracodorsal Artery
Perforator Flap
The Lateral Thigh Perforator
Flap
Conclusion
Acknowledgement
Perforator Flaps In Breast Reconstruction
Although the ideal material for reconstruction of the
breast is skin and fat alone, most current methods of
autogenous reconstruction use myocutaneous flaps. The
parent blood vessels to these flaps arise on the deep
surface of the muscle supplying the overlying skin and
fat via musculocutaneous perforators. By carefully dissecting
these perforating vessels as they course through the
muscle, flaps composed of skin and fat alone may be
harvested from various anatomic areas without the need
for muscle sacrifice. Advantages of this method include
no muscle function loss, no hernia formation, decreased
postoperative pain, and a shortened hospital stay. The
main drawback of the perforator flap is that meticulous
microvascular technique is required and may lengthen
the operative time. Donor sites that will be illustrated
in this chapter are the lower abdomen, the upper buttock,
the lower buttock, the back, and the lateral thigh.
The choice of a donor area is based on the location
of the most desirable donor tissue.
Editorial Comments
As the quality, of breast reconstruction has improved
dramatically over the last 20 years, it is logical that
at some point, perforator flaps, as described by, Dr.
Allen, would appear as new techniques to replace standard.
The TRAM flap and later the free TRAM flap both have
yielded outstanding results in breast reconstruction
and have served both patients and the medical community
well. The one drawback, in addition to the length and
magnitude of the surgery, has been the sacrifice of
some of the components of the abdominal wall. Dr. Allen
has taken the challenge and now has shown that the benefits
of a TRAM flap and other musculocutaneous flaps can
be achieved without a significant loss of muscle.
The results and technique that he has described in
this chapter are excellent, and the concept of this
operation is totally logical. The question remains whether
it will ever achieve wide acceptance in the community
of surgeons. The issues, of' course, are the difficulty
of the operation, the length of time it requires, and
the potential for total failure. Nevertheless, I expect
that some surgeons will embrace the perforator flap
for breast reconstruction and other reconstructions
because the results can be excellent and the concept
is exquisitely logical. The only procedure that I can
imagine that will ever replace this procedure would
be the transfer of homologous tissue from a tissue bank,
where there is no morbidity whatsoever associated with
the operation.
S. L. S.
Index
The Deep Inferior Epigastric
Perforator Flap
The Gluteal Artery Perforator
Flap
The Thoracodorsal Artery
Perforator Flap
The Lateral Thigh Perforator
Flap
Conclusion
Acknowledgement
R. J. Allen: Section of Plastic Surgery, Louisiana State
University Medical Center, New Orleans, Louisiana 70115.
