title: Preliminary Outcomes of Distal IMAP and SEAP Flaps for the Treatment of Unstable Keloids Subject to Recurrent Inflammation and Infections in the Lower Sternal and Upper Abdominal Areas.
abstract: BACKGROUND
  We present the clinical application of the sixth internal mammary artery perforator (IMAP) and superior epigastric artery perforator (SEAP) flaps for the treatment of defects resulting from the excision of large lower sternal and upper abdominal keloids. Perforator selection and flap design were based solely on preoperative multidetector-row computed tomographic angiography (MDCTA) of the areas adjacent to the soft tissue defects.
  
  
  METHODS
  Between January 2009 and June 2014, 15 patients with large, unstable keloids subject to recurrent inflammation and infections and with a history of multiple failed treatments underwent surgical excision and early postoperative radiation therapy. The defects were located in the upper abdomen (n = 6) or lower sternum (n = 9). All patients underwent preoperative MDCTA for perforator localization.
  
  
  RESULTS
  A total of 15 patients underwent keloid removal followed by IMAP (n = 10) and SEAP (n = 6) flap coverage combined with early postoperative low-dose radiation therapy (350 cGy/5 fractions/5 days or 400 cGy/4 fractions/4 days). Flap sizes ranged from 9 × 5 to 17 × 6 cm. Only one IMAP flap developed a 2 × 2 cm tip necrosis, which was managed with dressing changes. The remaining flaps healed uneventfully with no keloid recurrence at 23.4 months. In all cases, the perforator location determined by preoperative MDCTA was precisely consistent with the intraoperative findings.
  
  
  CONCLUSIONS
  The sixth IMAP and SEAP flaps combined with early postoperative radiation therapy provided a valid and feasible approach for the surgical treatment of large keloids in the lower sternal and upper abdominal. MDCTA enabled detailed preoperative assessment of the perforators, facilitating both flap design and dissection, and saving operating time. Although longer follow-up is required, these preliminary results are encouraging.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.
authors.forename: Jue
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.
authors.forename: Peiru
authors.initials: P
authors.lastname: Min
authors.affiliation: Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Grassetti
authors.affiliation: Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
authors.affiliation: Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic, Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Nicoli
authors.affiliation: Reconstructive Microsurgery Unit, Hospital of Florence, Florence, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Innocenti
authors.affiliation: Department of Plastic and Reconstructive Surgery, Marche Polytechnic University Medical School, University Hospital of Ancona, Ancona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Torresetti
authors.affiliation: Department of Orthopedic Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
authors.affiliation: Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Persichetti
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D019074:Epigastric Arteries; D005260:Female; D006801:Humans; D007249:Inflammation; D007627:Keloid / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008323:Mammary Arteries; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D012008:Recurrence; D013249:Sternum / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing