• Archives of Plastic Surgery
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• v.50 no.3
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• pp.311-314
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• 2023

In lower extremity reconstruction, the recipient vessel often requires long-range mechanical dilation because of extensive vasospasm or plaque formation induced by concomitant atherosclerosis. While a forceps dilator can be used to manipulate and dilate vessels approximately 1 cm from their end, a DeBakey vascular dilator can dilate long-range vessels. The authors successfully performed free flap reconstruction of the lower extremity using the DeBakey vascular dilator. Of the two patients who underwent lower extremity reconstruction, one had extensive vasospasm, and the other had plaques in the recipient arteries. Irrigation with 4% lidocaine and dilation of the lumen with a forceps dilator were insufficient to restore the normal arterial blood flow. Instead, a DeBakey vascular dilator with a 1-mm diameter tip was gently inserted into the lumen. Then, to overcome vessel resistance, the dilator gently advanced approximately 10 cm to dilate the recipient artery. Normal arterial blood flow was gushed out after dilating the vessel lumen using a DeBakey vascular dilator. The vascular anastomosis was performed, and intravenous heparin 5000 IU was administered immediately after anastomosis. Prophylactic low-molecular-weight-heparin (Clexane, 1 mg/kg) was administered subcutaneously to both patients for 14 days. The reconstructed flap survived without necrosis in either patient.

• Archives of Plastic Surgery
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• v.34 no.5
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• pp.569-573
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• 2007

Purpose: The selection of the recipient vessels in breast reconstruction has a great influence on the surgical result and the shape of the reconstructed breast. We would like to introduce the criteria for the selection of recipient vessels in delayed reconstruction of the breast. Methods: We studied 56 patients with delayed breast reconstruction using free TRAM flaps from April 1994 to December 2006. The thoracodorsal and the ipsilateral internal mammary vessels were used as recipients in 25 patients each, the opposite internal mammary vessels in 3 patients, the thoracoacromial vessels in 2 patients, and the transverse cervical artery with the cephalic vein in 1 patient. The survival rate of the flaps, the vessel diameter, the length of the pedicles, and the convenience of vessel dissection were studied. Results: The diameter of the recipient vessel did not influence the anastomosis. The operation time, the survival rate of flap, the postoperative complications showed no significant difference according to the recipient vessel. Dissection of the thoracodorsal vessels was tedious due to scar formation from the prior operation. Dissection of the internal mammary vessels proved to be relatively easy, and the required length of the pedicle was shorter than any other site, but the need for removal of rib cartilage makes this procedure inconvenient. Conclusion: The first choice of the recipient vessel in immediate breast reconstruction is the thoracodorsal vessels, but in cases of delayed reconstruction the internal mammary vessels are favored as the first choice, because the thoracodorsal vessels have a high unusability rate. If the ipsilateral internal mammary vessels prove to be useless, the contralateral vessels can be used. The thoracoacromial vessels are useful, when the mastectomy scar is located in the upper portion. The transverse cervical artery and the cephalic vein can serve as the last resort, if all other vessels are unreliable.

• Archives of Reconstructive Microsurgery
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• v.10 no.2
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• pp.105-110
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• 2001

Breast reconstruction is an aesthetically critical procedure and should be peformed to match the opposite breast in shape, contour, and position. Many methods were introduced to reconstruct the breast with autogenous tissue. But, free tissue transfer for breast reconstruction has become common method. The transverse rectus abdominis myocutaneous flap technique has been a widely accepted method of breast reconstruction after mastectomy, since the first introduction of free abdominoplasty flap in 1979. In breast reconstruction with a free flap the selection of suitable recipient vessels remains one of the most critical decision for surgeon. The most common recipient site for free flap breast reconstruction is the axillar system. But, the use of the axillary system as a recipient site limits flap movement and flexibility in breast shaping. The use of internal mammary vessels as a recipient site be able to achieve ideal breast symmetry, but that technique require the rib resection. The selection of suitable recipient vessels is most important for successful free tissue transfer. We have performed breast reconstruction with TRAM flaps anastomozed to the internal mammary vessel perforator. We came to the conclusion that this vessel perforator is useful as a recipient site in cases of immediate breast reconstruction with free TRAM flap.

• Archives of Plastic Surgery
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• v.46 no.6
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• pp.599-602
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• 2019

We report a case of autologous breast reconstruction in which a thoracodorsal vessel was used as a recipient vessel after a hypoplastic internal mammary vessel was found on preoperative computed tomography (CT) angiography. A 46-year-old woman with no underlying disease was scheduled to undergo skin-sparing mastectomy and breast reconstruction using a deep inferior epigastric artery perforator flap. Preoperative CT angiography showed segmental occlusion of the right subclavian artery with severe atherosclerosis and calcification near the origin of the internal mammary artery, with distal flow maintained by collateral branches. The thoracodorsal artery was selected to be the recipient vessel because CT showed that it was of adequate size and was not affected by atherosclerosis. The patient experienced no postoperative complications, and the flap survived with no vascular complications. The breasts were symmetrical at a 6-month follow-up. This case highlights that preoperative vascular imaging modalities may help surgeons avoid using diseased vessels as recipient vessels in free flap breast reconstructions.

• Archives of Craniofacial Surgery
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• v.24 no.3
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• pp.129-132
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• 2023

Scalp defects necessitate diverse approaches for successful reconstruction, taking into account factors such as defect size, surrounding tissue, and recipient vessel quality. This case report presents a challenging scenario involving a temporal scalp defect where ipsilateral recipient vessels were unavailable. The defect was effectively reconstructed utilizing a transposition flap and a latissimus dorsi free flap, which was anastomosed to the contralateral recipient vessels. Our report underscores the successful reconstruction of a scalp defect in the absence of ipsilateral recipient vessels, emphasizing the importance of employing appropriate surgical interventions without necessitating vessel grafts.

• Archives of Plastic Surgery
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• v.39 no.3
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• pp.216-221
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• 2012

Background : Nipple-sparing mastectomy (NSM) is gaining popularity due to its superior aesthetic results. When reconstructing the breast with free abdominal tissue transfer, we must readdress the recipient vessel, because NSM can cause difficulty in access to the chest vessel. Methods : Between June 2006 and March 2011, a total of 92 women underwent NSM with free abdominal tissue transfer. A lateral oblique incision was used for the nipple-sparing mastectomy. For recipient vessels, the internal mammary vessels were chosen if the mastectomy flap did not block access to the vessels. If it did, the thoracodorsal vessels were used. Age, degree of breast ptosis, weight of the mastectomy specimen, and related complications of the internal mammary vessel group and the thoracodorsal vessel group were compared. Results : Thoracodorsal vessels were used as recipient vessels in 59 cases, and internal mammary vessels in 33 cases including 4 cases with perforators of the internal mammary vessels. Breast reconstruction was successful in all cases except one case involving a total flap failure, which was replaced by a silicone gel implant. The internal mammary group and the thoracodorsal group were similar in terms of age, height, breast weight, and degree of ptosis. The flap related complications such as flap loss and take-back operation rates were not significantly different between the two groups. The rate of nipple necrosis was higher in the internal mammary group. Conclusions : The thoracodorsal vessels could produce comparable outcomes in breast reconstruction after nipple-sparing mastectomies. If access to internal mammary vessels is difficult, the thoracodorsal vessel can be a better choice.

• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.115-119
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• 1999

In breast reconstruction with a free flap following mastectomy, the recipient vessels most widely used are in the axillary system, which limits flap movement and flexibility in breast shaping. In addition, scarring and fibrosis can make dissection of the vessels difficult. We have performed 43 breast reconstructions using a free transverse rectus abdominis myocutaneous(TRAM) flap. In 10 cases out of 20 delayed reconstruction, we anastomosed to the internal mammary vessels rather than subscapular system. There has been no flap failure. The surgical techniques, advantages and limitations of the internal mammary system are presented. The internal mammary vessel are compared with the axillary vessels as a recipient vascular system.

• Archives of Reconstructive Microsurgery
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• v.1 no.1
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• pp.51-55
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• 1992

Problems of composite tissue transfer commonly arise when a single indispensable recipient vessel receives the graft vssel, and the graft vessel must be sutured in end-to-side fashion so as not todisturb the vascularity of the recipient vessel. The triangular flap in the recipient vessel wall gives an intact endothelial surface when the flow of blood stream is presented and may reduce the chance of anastomosis. We selected mature Wistar rats weighing over 450 grams to compare the conventional longitudinal slit from the triangular flap in the recipient carotid artery over bloood pressure and blood flow when the donor carotid artery was anastomosed in end-to-side fashion. In 30 minutes after anastomosis, maximum blood pressure measured in the donor carotid arterial side when the recipient arterial wall was fasioned with the longitudinal slit was recorded 114 mmHg and with the triangular flap 100mmHg. Minimum blood pressure with the longitudinal slit was 98mmHg and with the triangular flap 88mmHg. The amount of blood collected for 30 seconds in the conventional longitudinal slit was 1.18mg and in the triangular flap 0.78mg. Histology study in 30 minutes, the conventional longitudinal slit demonstrated the more hemorrhagic features around the suture material compared to that of the triangular. flap and, in the 7th day, the conventional longitudinal slit demonstrated the more prominent granulomatous reactions and vascular proliferations around the suture material compared to that of the triangular flap.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.716-721
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• 2014

Background The aim of this study was to review the recipient vessels used in our cases of facial reanimation with free functional muscle transfer and to identify patient variables that may predict when the facial vessels are absent. From this we present a protocol for vessel selection in cases when the facial artery and/or vein are absent. Methods Patients were identified from November 2006 to October 2013. Data was collected on patient demographics, facial palsy aetiology, history of previous facial surgery/trauma and flap/recipient vessels used. A standard operative approach was adopted and performed by a single surgeon. Results Eighty-seven eligible patients were identified for inclusion amongst which 98 hemifaces were operated upon. The facial artery and vein were the most commonly used recipient vessels (90% and 83% of patients, respectively). Commonly used alternative vessels were the transverse facial vein and superficial temporal artery. Those with congenital facial palsy were significantly more likely to lack a suitable facial vein (P=0.03) and those with a history of previous facial surgery or trauma were significantly more likely to have an absent facial artery and vein (P<0.05). Conclusions Our algorithm can help to guide vessel selection cases of facial reanimation with free functional muscle transfer. Amongst patients with congenital facial palsy or in those with a previous history of facial surgery or trauma, the facial vessels are more likely to be absent and so the surgeon should then look towards the transverse facial vein and superficial temporal artery as alternative recipient structures.

• Archives of Craniofacial Surgery
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• v.21 no.5
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• pp.269-275
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• 2020

Background: The advance in microsurgical technique has facilitated a proper approach for reconstruction of extensive head and neck defects. For the success of free tissue reconstruction, selection of the recipient vessel is one of the most important factors. However, the vascular anatomy of this region is very complex, and a clear guideline about this subject is still lacking. In this study, we present our 30 years of experiences of free tissue reconstruction for head and neck defects. Methods: In this retrospective study, we analyzed a total of 138 flaps in 127 patients who underwent head and neck reconstruction using free tissue transfer following tumor resection between October 1986 to August 2019. Patients who underwent facial palsy reconstruction were excluded. Medical records including patient's demographics, detailed operation notes, follow-up records, and photographs were collected and analyzed. Results: Among a total of 127 patients, 10 patients underwent a secondary operation due to cancer recurrence. The most commonly used type of flap was radial forearm flap (n=107), followed by the anterolateral thigh flap (n=18) and fibula flap (n=10). With regard to recipient vessels, superior thyroid artery was most commonly used in arterial anastomosis (58.7%), and internal jugular vein (51.3%) was the first choice for venous anastomosis. The flap survival rate was 100%. Four cases of venous thrombosis were resolved with thrombectomy and re-anastomosis. Conclusion: Superior thyroid artery and internal jugular vein were reliable choices as recipient vessels. Proper recipient vessel selection could improve the result of head and neck reconstruction.