[Clinical results and color-coded duplex ultrasound findings 4 years after conditioned TRAM flap-plasty].
Presented is a new technique in preoperative conditioning of the pedicled TRAM-flap employing an interventional-radiologic procedure, selective embolization of the deep inferior epigastric artery (DIEA). During a four year period in 40 patients with a mean age of 48.4 (31-66) years breast reconstruction was performed by a superiorly pedicled TRAM-flap following preoperative conditioning. 30 of 40 patients were eligible for follow-up one to five years postoperatively. The mean interval between embolization and surgery amounted to 3.6 months. In 25 of 30 cases embolization of the DIEA was performed bilaterally, in 5 of 30 cases unilaterally. 14 of 30 patients underwent preoperative radiotherapy for breast cancer. Applying CCDS the peak flow values were determined in the superior epigastric arteries (TRAM/contralateral side). Pre-embolization values (54.9 cm/s/55.8 cm/s), post-embolization values (57.2 cm/s/57.9 cm/s) and late postoperative values (61.0 cm/s/61.6 cm/s) proved a statistically significant effect of selective embolization on peak flow without relevant difference between TRAM and contralateral side (p < 0.05). Postoperative flap complications consisted of partial necrosis in 2 of 30, fat necrosis in 1 of 30, impaired would healing in 5 of 30 and postoperative bleeding in 2 of 30 cases. Abdominal would healing complications occurred in 5 of 30 cases, abdominal wall weakness was found in 8 of 30 and hernia formation in 4 of 30 cases. Corrective surgery was performed at the breast (TRAM-flap) in 22 of 30 and at the abdomen (donor site) in 9 of 30 cases. Patient acceptance concerning selective embolization and TRAM-flap surgery was very high. 29 of 30 patients confirmed that they would again choose this type of breast reconstruction. The pedicled TRAM-flap following preoperative conditioning by selective embolization of the DIEA constitutes a safe and reliable method of breast reconstruction with autogenous tissue. It is superior to the pedicled TRAM-flap without delay and offers definite advantages compared to alternative techniques of enhanced flap vascularization.
Scheufler
O
O
Abteilung für Hand- und Plastische, Städtischen Krankenhauses Zehlendorf, Akademisches Lehrkrankenhaus der Freien Universität Berlin.
Andresen
R
R
Kirsch
A
A
Banzer
D
D
Vaubel
E
E
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D004621:Embolization, Therapeutic; D019074:Epigastric Arteries / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D019194:Ischemic Preconditioning; D016462:Mammaplasty; D008875:Middle Aged; D009336:Necrosis; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D012039:Regional Blood Flow / Q000502:physiology; D013524:Surgical Flaps / Q000098:blood supply*; D018615:Ultrasonography, Doppler, Color