The Experts below are selected from a list of 144 Experts worldwide ranked by ideXlab platform
Nicolas Bertheuil - One of the best experts on this subject based on the ideXlab platform.
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Superior Epigastric Artery perforator flap for reconstruction of deep sternal wound infection
Microsurgery, 2021Co-Authors: Nicolas Bertheuil, Franckmarie Leclere, Farid Bekara, Eric Watier, Erwan Flecher, Jerome DuisitAbstract:Background The treatment of deep wound sternal infection requires loco-regional pedicled flaps, usually with muscular flaps. Perforator propeller flaps represent the ultimate progress in the history of reconstructive surgery. We report here our experience with the Superior Epigastric Artery perforator (SEAP) flaps to repair sternal defect. Patients and methods Six patients presenting deep sternal wounds infection were treated with SEAP propeller flap, between March 2015 and June 2017. The mean age was 71.5 (range 53-83) years. The mean length and width of the defect were 16.2 × 7 cm (ranging 8-20 × 4-10). An elliptical skin flap pedicled on the SEAP was harvested in the inframammary fold and rotated up to 90° to cover the defect. Results All SEAP flaps achieved a successful entire coverage of the defect. The mean size of the skin paddle of the flap was 20.2 × 7.3 cm (ranging 14-27 × 6-9). All flaps were able to provide a complete sternal wound cover. Venous congestion was present in five cases and adequately treated by leech therapy; necrosis was distal in one case, and interesting the entire superficial flap in two cases but with deep tissues remaining viable and able to cover the mediastinum: an infected flap required revision. Satisfyingly, at 2-years postoperative follow-up all-patients were alive with a successful mediastinal cover. Conclusions The SEAP Perforator propeller flap is an alternative to muscle flaps to achieve treatment of deep and large sternal wound infection.
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management of large sternal wound infections with the Superior Epigastric Artery perforator flap
The Annals of Thoracic Surgery, 2016Co-Authors: H Eburdery, J L Grolleau, C Berthier, Nicolas Bertheuil, Benoit ChaputAbstract:The management of sternal wound infections often requires pedicled flaps. In recent years, the emergence of perforator flaps has changed our management of wounds involving tissue loss. For sternal wounds, the Superior Epigastric Artery perforator (SEAP) flap can be used with the propeller procedure with minimal donor site morbidity. In our practice, this flap has replaced the traditional latissimus dorsi and pectoralis major flaps in the treatment of many sternal wounds. We report our experience with 4 patients with large sternal wound infection after cardiothoracic operations. The SEAP flap appears a safe alternative for low-morbidity coverage of sternal infections. Moreover, muscle flaps remain available in case the SEAP flap fails.
Benoit Chaput - One of the best experts on this subject based on the ideXlab platform.
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management of large sternal wound infections with the Superior Epigastric Artery perforator flap
The Annals of Thoracic Surgery, 2016Co-Authors: H Eburdery, J L Grolleau, C Berthier, Nicolas Bertheuil, Benoit ChaputAbstract:The management of sternal wound infections often requires pedicled flaps. In recent years, the emergence of perforator flaps has changed our management of wounds involving tissue loss. For sternal wounds, the Superior Epigastric Artery perforator (SEAP) flap can be used with the propeller procedure with minimal donor site morbidity. In our practice, this flap has replaced the traditional latissimus dorsi and pectoralis major flaps in the treatment of many sternal wounds. We report our experience with 4 patients with large sternal wound infection after cardiothoracic operations. The SEAP flap appears a safe alternative for low-morbidity coverage of sternal infections. Moreover, muscle flaps remain available in case the SEAP flap fails.
Jerome Duisit - One of the best experts on this subject based on the ideXlab platform.
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Superior Epigastric Artery perforator flap for reconstruction of deep sternal wound infection
Microsurgery, 2021Co-Authors: Nicolas Bertheuil, Franckmarie Leclere, Farid Bekara, Eric Watier, Erwan Flecher, Jerome DuisitAbstract:Background The treatment of deep wound sternal infection requires loco-regional pedicled flaps, usually with muscular flaps. Perforator propeller flaps represent the ultimate progress in the history of reconstructive surgery. We report here our experience with the Superior Epigastric Artery perforator (SEAP) flaps to repair sternal defect. Patients and methods Six patients presenting deep sternal wounds infection were treated with SEAP propeller flap, between March 2015 and June 2017. The mean age was 71.5 (range 53-83) years. The mean length and width of the defect were 16.2 × 7 cm (ranging 8-20 × 4-10). An elliptical skin flap pedicled on the SEAP was harvested in the inframammary fold and rotated up to 90° to cover the defect. Results All SEAP flaps achieved a successful entire coverage of the defect. The mean size of the skin paddle of the flap was 20.2 × 7.3 cm (ranging 14-27 × 6-9). All flaps were able to provide a complete sternal wound cover. Venous congestion was present in five cases and adequately treated by leech therapy; necrosis was distal in one case, and interesting the entire superficial flap in two cases but with deep tissues remaining viable and able to cover the mediastinum: an infected flap required revision. Satisfyingly, at 2-years postoperative follow-up all-patients were alive with a successful mediastinal cover. Conclusions The SEAP Perforator propeller flap is an alternative to muscle flaps to achieve treatment of deep and large sternal wound infection.
Hiko Hyakusoku - One of the best experts on this subject based on the ideXlab platform.
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anatomical study of pectoral intercostal perforators and clinical study of the pectoral intercostal perforator flap for hand reconstruction
Plastic and Reconstructive Surgery, 2009Co-Authors: Kotoho Oki, Masahiro Murakami, Kumiko Tanuma, Rei Ogawa, Hitoshi Ozawa, Hiko HyakusokuAbstract:Background: The authors have used pectoral intercostal perforator flaps to reconstruct burned or injured hands by staged transfer. This flap is designed with a narrow skin pedicle that includes intercostal perforators from the fifth to eighth intercostal spaces, with a wide flap area that lies on the upper abdomen. The distal area is thinned down to the subdermal vascular network level; thus, such flaps are called "superthin flaps" or subdermal vascular network flaps. In this article, the authors discuss the arterial networks associated with this flap and present clinical cases. Methods: The authors performed an anatomical study using 13 cadavers to obtain angiograms and dissect the anterior chest and abdominal region. Clinically, the authors retrospectively analyzed 21 cases over 13 years. Results: Anatomically, the anterior intercostal regions could be divided into three segments with regard to vascular supply to the skin and subcutaneous layer. In particular, in the fifth to eighth intercostal spaces, perforators communicated with one another to form a "latticework" pattern. In addition, the vascular territories participating in the pectoral intercostal perforator flap, that is, the intercostal perforators, the Superior Epigastric Artery system, and the deep inferior Epigastric Artery system, linked with each other through choke vessels. In the authors' clinical cases, functional and aesthetic results were satisfactory. Conclusions: The pectoral intercostal perforator flap was supported by the arterial networks among perforators in the intercostal spaces and in the upper abdomen. This flap is one useful method for reconstruction of the hand region, providing good quality in terms of thinness and texture.
Mark W Ashton - One of the best experts on this subject based on the ideXlab platform.
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deep Superior Epigastric Artery perforators anatomical study and clinical application in sternal reconstruction
Plastic and Reconstructive Surgery, 2009Co-Authors: Eldon Mah, Mark W Ashton, Warren M Rozen, Stephen FloodAbstract:[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.
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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 Matthew 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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establishing the case for ct angiography in the preoperative imaging of abdominal wall perforators
Microsurgery, 2008Co-Authors: Warren M Rozen, Mark W Ashton, Damien Grinsell, Damien L Stella, Timothy J Phillips, G I TaylorAbstract:Preoperative imaging of the donor site vasculature for deep inferior Epigastric Artery (DIEA) perforator flaps and other abdominal wall reconstructive flaps has become more commonplace. Abdominal wall computed tomography angiography (CTA) has been described as the most accurate and reproducible modality available for demonstrating the location, size, and course of individual perforators. We drew on our experience of 75 consecutive patients planned for DIEA-based flap surgery undertaking CTA at a single institution. Seven of these cases have been reported to highlight the utility of CTA for preoperative planning, emphasizing the unique information supplied by CTA that may influence operative outcome. Among all cases that underwent preoperative imaging with CTA, there was 100% flap survival, with no partial or complete flap necrosis. We found that in three of the cases described, the choice of operation was necessarily selected based on CTA findings (DIEA perforator flap, transverse rectus abdominis myocutaneous flap, and superficial Superior Epigastric Artery flap). In addition, three cases demonstrate that CTA findings may dictate the decision to operate at all, and one case demonstrates the utility of CTA for evaluating the entire abdominal contents for comorbid conditions. Our experience with CTA for abdominal wall perforator mapping has been highly beneficial. CTA may guide operative technique and improve perforator selection in uncomplicated cases, and in difficult cases it can guide the most appropriate operation or indeed if an operation is appropriate at all. This is particularly the case in the setting of comorbidities or previous abdominal surgery. © 2008 Wiley-Liss, Inc. Microsurgery, 2008.