title: [Rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction with deep inferior epigastric perforator flap].
abstract: OBJECTIVE
  To explore the feasibility and reliability of rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction and thoracic wall repair with deep inferior epigastric perforator (DIEP) flaps.
  
  
  METHODS
  Between November 2009 and September 2011, 11 female patients with post-mastectomy deformities were treated. The mean age was 42 years (range, 33-65 years). Of them, 10 patients underwent breast reconstruction with the DIEP flaps, and 1 patient received defect repair for chronic thoracic wall irradiated ulcer with the DIEP flap. The size of the flap ranged from 18 cm x 9 cm to 28 cm x 12 cm. Rib-sparing technique was applied in all these cases. The internal mammary vessels were exposed by dissection intercostal space and anastomosed with the deep inferior epigastric vessels. The donor sites were closed directly in all cases.
  
  
  RESULTS
  In all cases, the rib-sparing technique for internal mammary vessels exposure and anastomosis was successfully performed. The mean time for internal mammary vessels exposure was 52 minutes (range, 38-65 minutes). The mean exposure length of the internal mammary vessels was 1.7 cm (range, 1.3-2.2 cm). All flaps survived completely postoperatively, and wounds and incisions at donor sites healed primarily. All patients were followed up 8-26 months (mean, 12 months). All patients were satisfied with the reconstructive outcomes. No collapse deformity or discomfort of the thoracic wall occurred.
  
  
  CONCLUSIONS
  The rib-sparing technique for internal mammary vessels exposure and anastomosis is a reliable and reproducible approach to reconstruct the breast and repair the thoracic wall with DIEP flap, and it can reduce collapse deformity of the thoracic wall.
authors: Ang
authors: A
authors: Zeng
authors: Lin
authors: L
authors: Zhu
authors: Zhifei
authors: Z
authors: Liu
authors: Xiaojun
authors: X
authors: Wang
authors: Hailin
authors: H
authors: Zhang
authors: Ming
authors: M
authors: Bai
authors: Zhi
authors: Z
authors: Wang
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D001943:Breast Neoplasms / Q000534:rehabilitation* / Q000601:surgery; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008323:Mammary Arteries / Q000601:surgery*; D008408:Mastectomy; D008866:Microsurgery; D061525:Perforator Flap; D019651:Plastic Surgery Procedures / Q000379:methods*; D015203:Reproducibility of Results; D012272:Ribs; D013524:Surgical Flaps; D035441:Thoracic Wall