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Katsuyuki Arai - One of the best experts on this subject based on the ideXlab platform.

  • the deep inferior epigastric artery free skin flap anatomic study and clinical application
    Plastic and Reconstructive Surgery, 1993
    Co-Authors: Yoshiyasu Itoh, Katsuyuki Arai
    Abstract:

    We carried out an anatomic study to create the efficient surgical technique of elevating the inferior epigastric artery free skin flap. The deep inferior epigastric artery bifurcates into the lateral and medial branches. The former usually is larger in diameter and has many skin perforators slightly lateral to the midline of musculature. When a vascular pedicle skin flap is lifted without attaching the Rectus Abdominis Muscle or its anterior sheath, it seems more efficient if the flap uses the skin perforator belonging to the lateral branch. This is so because entry of the inferior epigastric artery is from the lateral side of the Rectus Abdominis Muscle and the lateral branch runs slightly lateral to the midline of the musculature and parallel to the run of the muscular fibers

  • the deep inferior epigastric artery free skin flap anatomic study and clinical application
    Plastic and Reconstructive Surgery, 1993
    Co-Authors: Yoshiyasu Itoh, Katsuyuki Arai
    Abstract:

    We carried out an anatomic study to create the efficient surgical technique of elevating the inferior epigastric artery free skin flap. The deep inferior epigastric artery bifurcates into the lateral and medial branches. The former usually is larger in diameter and has many skin perforators slightly lateral to the midline of musculature. When a vascular pedicle skin flap is lifted without attaching the Rectus Abdominis Muscle or its anterior sheath, it seems more efficient if the flap uses the skin perforator belonging to the lateral branch. This is so because entry of the inferior epigastric artery is from the lateral side of the Rectus Abdominis Muscle and the lateral branch runs slightly lateral to the midline of the musculature and parallel to the run of the muscular fibers. This would be easier technically and would minimize the damage to the Muscle when detaching the lateral branch.

Yoshiyasu Itoh - One of the best experts on this subject based on the ideXlab platform.

  • the deep inferior epigastric artery free skin flap anatomic study and clinical application
    Plastic and Reconstructive Surgery, 1993
    Co-Authors: Yoshiyasu Itoh, Katsuyuki Arai
    Abstract:

    We carried out an anatomic study to create the efficient surgical technique of elevating the inferior epigastric artery free skin flap. The deep inferior epigastric artery bifurcates into the lateral and medial branches. The former usually is larger in diameter and has many skin perforators slightly lateral to the midline of musculature. When a vascular pedicle skin flap is lifted without attaching the Rectus Abdominis Muscle or its anterior sheath, it seems more efficient if the flap uses the skin perforator belonging to the lateral branch. This is so because entry of the inferior epigastric artery is from the lateral side of the Rectus Abdominis Muscle and the lateral branch runs slightly lateral to the midline of the musculature and parallel to the run of the muscular fibers

  • the deep inferior epigastric artery free skin flap anatomic study and clinical application
    Plastic and Reconstructive Surgery, 1993
    Co-Authors: Yoshiyasu Itoh, Katsuyuki Arai
    Abstract:

    We carried out an anatomic study to create the efficient surgical technique of elevating the inferior epigastric artery free skin flap. The deep inferior epigastric artery bifurcates into the lateral and medial branches. The former usually is larger in diameter and has many skin perforators slightly lateral to the midline of musculature. When a vascular pedicle skin flap is lifted without attaching the Rectus Abdominis Muscle or its anterior sheath, it seems more efficient if the flap uses the skin perforator belonging to the lateral branch. This is so because entry of the inferior epigastric artery is from the lateral side of the Rectus Abdominis Muscle and the lateral branch runs slightly lateral to the midline of the musculature and parallel to the run of the muscular fibers. This would be easier technically and would minimize the damage to the Muscle when detaching the lateral branch.

Geoffrey G. Hallock - One of the best experts on this subject based on the ideXlab platform.

  • An introduction to the chimeric deep inferior epigastric artery perforator (DIEAP)-Rectus Abdominis Muscle flap.
    Annals of plastic surgery, 2008
    Co-Authors: Geoffrey G. Hallock
    Abstract:

    A Muscle perforator flap is a unique form of fasciocutaneous flap whose circulation is derived from musculocutaneous perforators, but without including any Muscle. This anatomic relationship intuitively should readily allow the formation of branch-based chimeric or polyflaps consisting of a cutaneous perforator flap and its corresponding Muscle as a combined flap, both ultimately supplied by a common source vessel. Many versions of the Rectus Abdominis musculocutaneous flap based on the deep inferior epigastric vessels are well known, but formation of a chimeric flap consisting of its component parts has heretofore not been reported. This treatise is intended primarily to provide an anatomic description that introduces the deep inferior epigastric artery perforator (DIEAP)-Rectus Abdominis Muscle chimeric flap, with a clinical example that mainly demonstrated its usefulness to be the aesthetic advantage of a concomitant abdominoplasty.

  • the pectoralis major Muscle extended island flap for complete obliteration of the median sternotomy wound
    Annals of Plastic Surgery, 2007
    Co-Authors: Geoffrey G. Hallock
    Abstract:

    The sequence of adverse events initiated by a sternal wound infection today can typically be ameliorated by interposing a vascularized flap. The pectoralis major Muscle due to its propinquity has universally been the workhorse flap for minimizing this dilemma, with our experience over the past 25 years being no exception as 123 of 156 patients so inflicted required this donor site in some format. However, a Rectus Abdominis Muscle had to be used in combination in 22 patients, particularly for coverage of the xiphoid region, and this can add significant morbidity in an already compromised patient population. This conundrum provided the impetus starting in 2003 for the development of a pectoralis major Muscle extended island flap, whereby skeletonizing its vascular pedicle back to near the origin of the thoracoacromial axis, the desired extended reach can be obtained. Since that time, 18 pectoralis major Muscle extended island flaps have been successfully used, with only a single wound complication still requiring use of a Rectus Abdominis Muscle flap. This has proven to be a reliable option that alone allows complete closure of the median sternotomy wound while avoiding the need for combined flaps with preservation of the Rectus Abdominis Muscle.

  • The superior epigastric(Rectus Abdominis) Muscle perforator flap.
    Annals of plastic surgery, 2005
    Co-Authors: Geoffrey G. Hallock
    Abstract:

    The concept of the Muscle perforator flap has been proven valid repeatedly, now including the territories of almost all known musculocutaneous flap donor sites. It is well known that the Rectus Abdominis Muscle has a dual vascular supply from 2 dominant source vessels. Yet only the deep inferior epigastric vessels have been used for a relatively long time to supply the well-known D1EP Muscle perforator flap. Logically, as previously predicted in this journal, a Muscle perforator flap utilizing the cephalic pedicle to the Rectus Abdominis Muscle should also be possible. This prophecy has now become a reality in this first report where a superior epigastric RECFUS Abdominis Muscle perforator flap was used successfully as a local flap to close a chest defect.

  • physiologic superiority of the anatomic dominant pedicle of the tram flap in a rat model
    Plastic and Reconstructive Surgery, 1995
    Co-Authors: Geoffrey G. Hallock, David C Rice
    Abstract:

    Despite an extensive knowledge of the anatomic nuances of the Rectus Abdominis Muscle and corresponding relationship to the vascularization of the skin of the abdomen, the clinical outcome when used as a musculocutaneous flap cannot always be predictable. Only a few human physiologic studies have been attempted to explain this discrepancy. Further laboratory investigations of the anatomy and physiology of the rat transverse Rectus Abdominis musculocutaneous (TRAM) flap suggest that this is a safer, comparable, yet inexpensive animal model for studying further the dynamics of this flap. By caliber and course, the major source vessel to the Rectus Abdominis Muscle in the Sprague-Dawley rat enters superiorly as the cranial epigastric artery, which is a continuation of the internal thoracic (mammary) artery. Anatomic dissections in 13 rats revealed, on average, that 4.7 ± 0.97 large musculocutaneous perforators emanated from each cranial epigastric artery at regular intervals which then proceeded directly to the overlying abdominal integument. Just below the umbilicus, a watershed is formed by small choke anastomoses to a frequently vestigial caudal epigastric artery or, more commonly, a true anastomosis with a branch of the deep circumflex iliac artery. In 10 additional rats, TRAM flaps encompassing the skin of the entire abdominal wall were then elevated so as to rely on a single pedicle, alternating randomly from either source. By laser Doppler flowmetry, blood flow by means of the larger-caliber superior pedicle exceeded twice that of the subservient inferior pedicle. Ultimate viable surface area of the superiorly based rat TRAM flap was 72.8 ± 12.83 percent of the original as opposed to 44.8 ± 18.07 percent of identical flaps if based inferiorly. Both differences were statistically significant (p < 0.002 and p < 0.03, respectively), verifying the physiologic superiority of the cranial epigastric artery as the dominant source vessel to the rat Rectus Abdominis Muscle and that skin territory nourished by its perforators. (Plast. Reconstr. Surg. 96 : 111, 1995.)

Paul N. Manson - One of the best experts on this subject based on the ideXlab platform.

  • Contour abnormalities of the abdomen after transverse Rectus Abdominis Muscle flap breast reconstruction: a multifactorial analysis.
    Plastic and reconstructive surgery, 2002
    Co-Authors: Maurice Y. Nahabedian, Paul N. Manson
    Abstract:

    Contour abnormalities of the abdomen after transverse Rectus Abdominis Muscle (TRAM) flap breast reconstruction occur with all methods of flap elevation and include lower and upper abdominal laxity, epigastric fullness, and hernia. This study is a retrospective analysis of 101 women comparing the many variables that may contribute to an abnormal contour. Statistical analysis comparing the free, pedicled, unilateral, bilateral, Muscle-sparing, and non-Muscle-sparing flaps was completed using logistic regression. Associated factors, including diabetes mellitus, tobacco use, use of mesh, and prior abdominal operations, were incorporated. Abnormal abdominal contour was present in 13 of 101 women and included 16 specific abnormalities. These included upper abdominal bulge in three women, lower abdominal bulge in eight, and epigastric fullness in five. No woman developed a hernia. Bifactorial analysis demonstrated a significant increase in abnormal contour for the pedicled, bilateral, and non-Muscle-sparing TRAM groups when compared with their countervariable groups (free, unilateral, and Muscle-sparing TRAM, respectively; p < 0.05). Multifactorial analysis demonstrated a significant increase in abnormal contour in two subgroups (p < 0.05). An analysis of associated factors demonstrated a significant increase in abnormal contour for the bilateral TRAM in the presence of a prior lower midline incision (p < 0.05).

  • contour abnormalities of the abdomen after transverse Rectus Abdominis Muscle flap breast reconstruction a multifactorial analysis
    Plastic and Reconstructive Surgery, 2002
    Co-Authors: Maurice Y. Nahabedian, Paul N. Manson
    Abstract:

    Contour abnormalities of the abdomen after transverse Rectus Abdominis Muscle (TRAM) flap breast reconstruction occur with all methods of flap elevation and include lower and upper abdominal laxity, epigastric fullness, and hernia. This study is a retrospective analysis of 101 women comparing the ma

  • contour abnormalities of the abdomen after breast reconstruction with abdominal flaps the role of Muscle preservation
    Plastic and Reconstructive Surgery, 2002
    Co-Authors: Maurice Y. Nahabedian, William C Dooley, Navin K Singh, Paul N. Manson
    Abstract:

    The purpose of the present study was to determine whether contour abnormalities of the abdomen after breast reconstruction with abdominal flaps are related to the harvest of the Rectus Abdominis Muscle. Abdominal contour was analyzed in 155 women who had breast reconstruction with abdominal flaps; 1

Stephen Flood - One of the best experts on this subject based on the ideXlab platform.

  • deep superior epigastric artery perforators anatomical study and clinical application in sternal reconstruction
    Plastic and Reconstructive Surgery, 2009
    Co-Authors: Eldon Mah, Mark W. Ashton, Warren M Rozen, Stephen Flood
    Abstract:

    [Extract] Perforators of the deep superior epigastric artery traverse the Rectus Abdominis Muscle to supply the upper abdominal wall integument. These perforators have been used in the past as the basis for vertical and transverse Rectus Abdominis myocutaneous flaps,1–4 and for thoracoepigastric fasciocutaneous flaps. Although flaps based on deep superior epigastric artery perforators have been described in a range of clinical settings, we would like to share our experience in applying this flap for sternal reconstruction. Sternal wound dehiscence is a challenging reconstructive problem, with reconstructive options including Rectus Abdominis Muscle, pectoralis major Muscle, and omentum, but situations exist where these are not feasible and other options are sought. The current study contributes to this list of options by reporting our experience with the deep superior epigastric artery perforator/thoracoepigastric flap for difficult sternal reconstructions. In developing this flap, we undertook an anatomical study with clinical computed tomographic angiography studies to improve flap design. Although previous cadaveric studies have delineated some of this anatomy, in vivo clinical studies of this anatomy have been sparse.