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Warren M Rozen - One of the best experts on this subject based on the ideXlab platform.
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the absent Inferior Epigastric Artery a unique anomaly and implications for deep Inferior Epigastric Artery perforator flaps
Journal of Reconstructive Microsurgery, 2009Co-Authors: Warren M Rozen, Nicholas D Houseman, Mark W AshtonAbstract:The abdominal wall is particularly advantageous as a donor site due to the reliability of its vascular supply. Although the cutaneous perforators of the deep Inferior Epigastric Artery (DIEA) and the superficial Inferior Epigastric Artery (SIEA) may show significant individual variability, the DIEA itself has been shown to be ever-present as a vascular pedicle and to be highly dependable. The increasing use of preoperative computed tomographic angiography (CTA) has led to increasing reports of anatomic variability. With the use of preoperative CTA, we describe a unique case of a completely absent DIEA in patient who had not previously undergone any open abdominal surgery. The absence of the DIEA had led to vascular changes throughout the abdominal wall, including dilatation of both SIEAs and the ipsilateral deep superior Epigastric Artery. Preoperative CTA in this setting helped us identify this anomaly and aided surgical planning. The incidence of this anomaly was subsequently reviewed in 150 consecutive CTA scans performed at our institution.
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thermal injuries in the insensate deep Inferior Epigastric Artery perforator flap case series and literature review on mechanisms of injury
Microsurgery, 2009Co-Authors: Morteza Enajat, Warren M Rozen, Thorir Audolfsson, Rafael AcostaAbstract:With the increasing use of the deep Inferior Epigastric Artery perforator (DIEP) flap, complications that are particularly rare (less than 1%) may start to become clinically relevant. During DIEP f ...
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advances in the pre operative planning of deep Inferior Epigastric Artery perforator flaps magnetic resonance angiography
Microsurgery, 2009Co-Authors: Warren M Rozen, Ian G Taylor, Damien L Stella, James Bowden, Mark W AshtonAbstract:: Imaging of the abdominal wall vasculature prior to deep Inferior Epigastric Artery (DIEA) perforator (DIEP) flaps has been shown to significantly improve surgical outcomes. Although computed tomography angiography (CTA) has been shown to be highly accurate, it is associated with radiation exposure, and as such modalities without radiation exposure have been sought. Magnetic resonance angiography (MRA) has been proposed as such an option. We conducted a pilot study comparing MRA with CTA and with operative findings in six consecutive patients undergoing DIEP flaps for breast reconstruction. The DIEA, superficial Inferior Epigastric Artery (SIEA) and perforators were all assessed with each modality. We found that the DIEA and SIEA were accurately imaged with both CTA and MRA, but that while MRA could identify some major perforators, CTA was more accurate than MRA for perforator mapping. As such, while MRA does have a role in the imaging of DIEA perforators, CTA is still the preferred modality. On the basis of these findings, a larger study into the role for MRA in this setting is warranted.
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the accuracy of computed tomographic angiography for mapping the perforators of the deep Inferior Epigastric Artery a blinded prospective cohort study
Plastic and Reconstructive Surgery, 2008Co-Authors: Warren M Rozen, Mark W Ashton, Damien L Stella, Timothy J Phillips, Damien Grinsell, Ian G TaylorAbstract:BACKGROUND: The deep Inferior Epigastric Artery perforator flap is increasingly used for autologous breast reconstruction, with low donor-site morbidity cited as a major advantage of this operation. Preoperative imaging of the donor-site vasculature is frequently used as a further means of improving operative outcome. Computed tomographic angiography has been increasingly described as a preferred imaging modality; however, its formal evaluation has not been described in a clinical setting. METHODS: A prospective, single-blind, cohort study was undertaken on 60 consecutive patients for whom deep Inferior Epigastric Artery perforator flap surgery had been planned. Patients who did not undergo the procedure during the study period were excluded, with 42 patients ultimately included in the study. All computed tomographic angiography scans were obtained at a single institution. Perforators were mapped both on angiography and intraoperatively using a grid of 4-mm squares centered on the umbilicus. Only perforators larger than 1 mm were included in the study. All imaging findings were recorded by a single operator, and all intraoperative findings were recorded by the operating surgeon. RESULTS: Computed tomographic angiography identified 280 major perforators in 42 patients. It was highly accurate, demonstrating 279 perforators recorded accurately, with one false-positive and one false-negative. Its sensitivity for mapping perforators was thus 99.6 percent, with a positive predictive value of 99.6 percent. CONCLUSIONS: Computed tomographic angiography is highly accurate in identifying and mapping the perforators of the deep Inferior Epigastric Artery. Its accuracy is superior to that of the previous modalities used in this role and suggests the usefulness of this technique before deep Inferior Epigastric Artery perforator flap surgery for breast reconstruction.
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raising perforator flaps for breast reconstruction the intramuscular anatomy of the deep Inferior Epigastric Artery
Plastic and Reconstructive Surgery, 2007Co-Authors: Warren M Rozen, Mark W Ashton, Ian G TaylorAbstract:Background:The deep Inferior Epigastric Artery (DIEA) perforator flap is used increasingly for breast reconstruction, preferred as a muscle-sparing operation over traditional transverse rectus abdominis musculocutaneous (TRAM) flaps. Complications related to the inclusion of rectus abdominis include
Ian G Taylor - One of the best experts on this subject based on the ideXlab platform.
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advances in the pre operative planning of deep Inferior Epigastric Artery perforator flaps magnetic resonance angiography
Microsurgery, 2009Co-Authors: Warren M Rozen, Ian G Taylor, Damien L Stella, James Bowden, Mark W AshtonAbstract:: Imaging of the abdominal wall vasculature prior to deep Inferior Epigastric Artery (DIEA) perforator (DIEP) flaps has been shown to significantly improve surgical outcomes. Although computed tomography angiography (CTA) has been shown to be highly accurate, it is associated with radiation exposure, and as such modalities without radiation exposure have been sought. Magnetic resonance angiography (MRA) has been proposed as such an option. We conducted a pilot study comparing MRA with CTA and with operative findings in six consecutive patients undergoing DIEP flaps for breast reconstruction. The DIEA, superficial Inferior Epigastric Artery (SIEA) and perforators were all assessed with each modality. We found that the DIEA and SIEA were accurately imaged with both CTA and MRA, but that while MRA could identify some major perforators, CTA was more accurate than MRA for perforator mapping. As such, while MRA does have a role in the imaging of DIEA perforators, CTA is still the preferred modality. On the basis of these findings, a larger study into the role for MRA in this setting is warranted.
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the accuracy of computed tomographic angiography for mapping the perforators of the deep Inferior Epigastric Artery a blinded prospective cohort study
Plastic and Reconstructive Surgery, 2008Co-Authors: Warren M Rozen, Mark W Ashton, Damien L Stella, Timothy J Phillips, Damien Grinsell, Ian G TaylorAbstract:BACKGROUND: The deep Inferior Epigastric Artery perforator flap is increasingly used for autologous breast reconstruction, with low donor-site morbidity cited as a major advantage of this operation. Preoperative imaging of the donor-site vasculature is frequently used as a further means of improving operative outcome. Computed tomographic angiography has been increasingly described as a preferred imaging modality; however, its formal evaluation has not been described in a clinical setting. METHODS: A prospective, single-blind, cohort study was undertaken on 60 consecutive patients for whom deep Inferior Epigastric Artery perforator flap surgery had been planned. Patients who did not undergo the procedure during the study period were excluded, with 42 patients ultimately included in the study. All computed tomographic angiography scans were obtained at a single institution. Perforators were mapped both on angiography and intraoperatively using a grid of 4-mm squares centered on the umbilicus. Only perforators larger than 1 mm were included in the study. All imaging findings were recorded by a single operator, and all intraoperative findings were recorded by the operating surgeon. RESULTS: Computed tomographic angiography identified 280 major perforators in 42 patients. It was highly accurate, demonstrating 279 perforators recorded accurately, with one false-positive and one false-negative. Its sensitivity for mapping perforators was thus 99.6 percent, with a positive predictive value of 99.6 percent. CONCLUSIONS: Computed tomographic angiography is highly accurate in identifying and mapping the perforators of the deep Inferior Epigastric Artery. Its accuracy is superior to that of the previous modalities used in this role and suggests the usefulness of this technique before deep Inferior Epigastric Artery perforator flap surgery for breast reconstruction.
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raising perforator flaps for breast reconstruction the intramuscular anatomy of the deep Inferior Epigastric Artery
Plastic and Reconstructive Surgery, 2007Co-Authors: Warren M Rozen, Mark W Ashton, Ian G TaylorAbstract:Background:The deep Inferior Epigastric Artery (DIEA) perforator flap is used increasingly for breast reconstruction, preferred as a muscle-sparing operation over traditional transverse rectus abdominis musculocutaneous (TRAM) flaps. Complications related to the inclusion of rectus abdominis include
Mark W Ashton - One of the best experts on this subject based on the ideXlab platform.
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the absent Inferior Epigastric Artery a unique anomaly and implications for deep Inferior Epigastric Artery perforator flaps
Journal of Reconstructive Microsurgery, 2009Co-Authors: Warren M Rozen, Nicholas D Houseman, Mark W AshtonAbstract:The abdominal wall is particularly advantageous as a donor site due to the reliability of its vascular supply. Although the cutaneous perforators of the deep Inferior Epigastric Artery (DIEA) and the superficial Inferior Epigastric Artery (SIEA) may show significant individual variability, the DIEA itself has been shown to be ever-present as a vascular pedicle and to be highly dependable. The increasing use of preoperative computed tomographic angiography (CTA) has led to increasing reports of anatomic variability. With the use of preoperative CTA, we describe a unique case of a completely absent DIEA in patient who had not previously undergone any open abdominal surgery. The absence of the DIEA had led to vascular changes throughout the abdominal wall, including dilatation of both SIEAs and the ipsilateral deep superior Epigastric Artery. Preoperative CTA in this setting helped us identify this anomaly and aided surgical planning. The incidence of this anomaly was subsequently reviewed in 150 consecutive CTA scans performed at our institution.
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advances in the pre operative planning of deep Inferior Epigastric Artery perforator flaps magnetic resonance angiography
Microsurgery, 2009Co-Authors: Warren M Rozen, Ian G Taylor, Damien L Stella, James Bowden, Mark W AshtonAbstract:: Imaging of the abdominal wall vasculature prior to deep Inferior Epigastric Artery (DIEA) perforator (DIEP) flaps has been shown to significantly improve surgical outcomes. Although computed tomography angiography (CTA) has been shown to be highly accurate, it is associated with radiation exposure, and as such modalities without radiation exposure have been sought. Magnetic resonance angiography (MRA) has been proposed as such an option. We conducted a pilot study comparing MRA with CTA and with operative findings in six consecutive patients undergoing DIEP flaps for breast reconstruction. The DIEA, superficial Inferior Epigastric Artery (SIEA) and perforators were all assessed with each modality. We found that the DIEA and SIEA were accurately imaged with both CTA and MRA, but that while MRA could identify some major perforators, CTA was more accurate than MRA for perforator mapping. As such, while MRA does have a role in the imaging of DIEA perforators, CTA is still the preferred modality. On the basis of these findings, a larger study into the role for MRA in this setting is warranted.
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the accuracy of computed tomographic angiography for mapping the perforators of the deep Inferior Epigastric Artery a blinded prospective cohort study
Plastic and Reconstructive Surgery, 2008Co-Authors: Warren M Rozen, Mark W Ashton, Damien L Stella, Timothy J Phillips, Damien Grinsell, Ian G TaylorAbstract:BACKGROUND: The deep Inferior Epigastric Artery perforator flap is increasingly used for autologous breast reconstruction, with low donor-site morbidity cited as a major advantage of this operation. Preoperative imaging of the donor-site vasculature is frequently used as a further means of improving operative outcome. Computed tomographic angiography has been increasingly described as a preferred imaging modality; however, its formal evaluation has not been described in a clinical setting. METHODS: A prospective, single-blind, cohort study was undertaken on 60 consecutive patients for whom deep Inferior Epigastric Artery perforator flap surgery had been planned. Patients who did not undergo the procedure during the study period were excluded, with 42 patients ultimately included in the study. All computed tomographic angiography scans were obtained at a single institution. Perforators were mapped both on angiography and intraoperatively using a grid of 4-mm squares centered on the umbilicus. Only perforators larger than 1 mm were included in the study. All imaging findings were recorded by a single operator, and all intraoperative findings were recorded by the operating surgeon. RESULTS: Computed tomographic angiography identified 280 major perforators in 42 patients. It was highly accurate, demonstrating 279 perforators recorded accurately, with one false-positive and one false-negative. Its sensitivity for mapping perforators was thus 99.6 percent, with a positive predictive value of 99.6 percent. CONCLUSIONS: Computed tomographic angiography is highly accurate in identifying and mapping the perforators of the deep Inferior Epigastric Artery. Its accuracy is superior to that of the previous modalities used in this role and suggests the usefulness of this technique before deep Inferior Epigastric Artery perforator flap surgery for breast reconstruction.
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raising perforator flaps for breast reconstruction the intramuscular anatomy of the deep Inferior Epigastric Artery
Plastic and Reconstructive Surgery, 2007Co-Authors: Warren M Rozen, Mark W Ashton, Ian G TaylorAbstract:Background:The deep Inferior Epigastric Artery (DIEA) perforator flap is used increasingly for breast reconstruction, preferred as a muscle-sparing operation over traditional transverse rectus abdominis musculocutaneous (TRAM) flaps. Complications related to the inclusion of rectus abdominis include
Michel Saintcyr - One of the best experts on this subject based on the ideXlab platform.
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vascular anatomy of the deep Inferior Epigastric Artery perforator flap a systematic review
Plastic and Reconstructive Surgery, 2014Co-Authors: Jordan E Ireton, Chrisovalantis Lakhiani, Michel SaintcyrAbstract:BACKGROUND: The deep Inferior Epigastric Artery perforator (DIEP) flap is one of the most commonly used perforator flaps for reconstruction. The anatomy of the flap varies considerably between patients and even within patients. The authors conducted a comprehensive review to fully describe the vascular anatomy of the DIEP flap. METHODS: The authors performed MEDLINE, Ovid, and PubMed searches for articles published between 1993 and 2012 on the vascular anatomy of the DIEP flap. Abstracts were screened first, then entire articles, followed by manual reference check. A total of 60 relevant articles were identified and reviewed in their entirety. The authors synthesized all descriptions of DIEP flap vascular anatomy. RESULTS: The perforators originating from the deep Inferior Epigastric Artery can be categorized as musculocutaneous or extramuscular. Musculocutaneous perforators are the most common (33 to 100 percent), followed by extramuscular (0 to 67.6 percent). Of the musculocutaneous perforators, a short intramuscular course ( 4 cm; 9 to 26 percent) and a perpendicular course (3 to 26 percent). Two subfascial patterns have been described, with direct fascial penetration more common than a subfascial course. The two extramuscular perforator types, paramedian (<46.4 percent) and tendinous (<67.6 percent), are the most desirable for dissection. CONCLUSIONS: The vascular anatomy of the DIEP flap shows significant variability. Despite this, several patterns of musculocutaneous and extramuscular-type perforators have been found. A greater understanding of these patterns will improve knowledge of the anatomical variation and will enhance the use of evidence-based perforator selection.
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arterial and venous anatomies of the deep Inferior Epigastric perforator and superficial Inferior Epigastric Artery flaps
Plastic and Reconstructive Surgery, 2008Co-Authors: Mark Victor Schaverien, Michel Saintcyr, Gary Arbique, Spencer A BrownAbstract:Background:This study uses three- and four-dimensional computed tomographic angiography and venography to evaluate the microvascular anatomy and perfusion of the deep Inferior Epigastric Artery perforator (DIEP) and superficial Inferior Epigastric Artery (SIEA) flaps.Methods:Ten DIEP flaps harvested
G M Baxter - One of the best experts on this subject based on the ideXlab platform.
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Case report Inferior Epigastric Artery pseudoaneurysm: ultrasound diagnosis and treatment with percutaneous thrombin
2020Co-Authors: A G S Shabani, G M BaxterAbstract:A case of a pseudoaneurysm arising from the Inferior Epigastric Artery in a patient presenting with a rectus sheath haematoma is reported. The pseudoaneurysm was successfully treated by percutaneous injection of human thrombin. Pseudoaneurysm of the Inferior Epigastric Artery is a recognized complication of surgery, trauma and arterial puncture (1-3). To our knowledge only eight cases have been reported; five following the extraction of retention sutures (1-5), two following paracentesis (6), and one following Tenckhoff catheter removal (7). We report a very rare case of spontaneous pseudoaneurysm arising from the Inferior epigas- tric Artery. The role of colour Doppler ultrasound in the diagnosis and management of this pseudo- aneurysm are described.
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Inferior Epigastric Artery pseudoaneurysm ultrasound diagnosis and treatment with percutaneous thrombin
British Journal of Radiology, 2002Co-Authors: A G S Shabani, G M BaxterAbstract:A case of a pseudoaneurysm arising from the Inferior Epigastric Artery in a patient presenting with a rectus sheath haematoma is reported. The pseudoaneurysm was successfully treated by percutaneous injection of human thrombin.