Dcia perforator flap book

The book outlines techniques for flap harvest, from the most basic to the highly advanced. The superior gluteal artery perforator sgap flap uses tissue from the top of the buttocks to create breast tissue. Compared to the superficial circumflex iliac artery perforator flap. Evolution of flaps has continued after the introduction of fasciocutaneous and musculocutaneous flaps. This comprehensive video library includes 29 perforator and axial pattern skin flap dissections in the head and neck, trunk, and upper and lower extremity.

The deep circumflex iliac artery perforator flap dciapa. Dcia free flap this leaflet has been designed to improve your understanding of any forthcoming treatment and contains answers to many of the commonly asked questions. An assessment of the anatomical basis of the thoracoacromial. Free flap breast reconstruction is a type of autologoustissue breast reconstruction applied after mastectomy for breast cancer, without the emplacement of a breast implant prosthesis. The dcia perforator flap has been used to supply musculocutaneous flaps for lowerlimb and breast reconstruction. Its use is described in detail, as is use of other less common perforator flaps. This flap has many of the desirable qualities of an ideal flap for reconstruction of composite defects of the maxilla and mandible. For the successful reconstruction of facial defects, various perforator flaps have been used in singlestage surgery, where tissues are moved to adjacent defect sites. We describe reconstructions with dciap flaps in 3 patients with large mandibular composite segmental defects. The flap can be harvested simultaneously with resection or preparation of the recipient bed. Body lift breast reconstruction with extended diep flaps.

The skin paddle can make the flap quite thick however, often making inset difficult. Jan 30, 2017 the anterolateral thigh alt free flap is frequently used in the head and neck. The penn human tissue laboratory is a state of the art facility where we will have demonstrations of flap dissections by leaders in the field of reconstructive microsurgery. The patient is positioned supine on the operating table with the hip and knee slightly flexed and internally rotated and maintained in that position. Groin flap and superficial circumflex iliac artery. We are very pleased to announce the penn flap course to be held on august 1416, 2020 at the human tissue laboratory of the university of pennsylvania. Random and pedicled flaps as well as free muscle and fasciocutaneous flaps have helped to reconstruct single softtissue defects. The flap was used either as the sole method of reconstruction, or in combination with a diep flap as part of a 2 flap to one breast method of. The deep circumflex iliac artery perforator flap for. However, its popularity was lost essentially due to variable arterial anatomy. Imaging findings, clinical course, and outcomes are presented. Basics of microvascular reconstruction of maxillomandibular. Initial descriptions of perforator flaps in 1989 by koshima and soeda, by using a musculocutaneous flap with an inferior epigastric arterybased skin island for reconstruction of defects involving the floor of mouth and groin, have led to significant additional advancements in the understanding of perforator flaps and vascular anatomy. This new edition has been updated to include ten new chapters and extensive updates on all existing chapters.

This atlas is organized in a way with a combination of basic theory and clinical practices, and of real photos and text description in perforator flap. Developments in imageguided deep circumflex iliac artery. The iliac crest and fibula flaps had bone dimensions consistently. Osteocutaneous flap an overview sciencedirect topics. Facial reconstruction with a unique osteomyocutaneous dcia perforator flap variant.

Nonmuscle perforator flaps, in particular neurocutaneous perforator flaps, are also discussed in this section. It shows the surgical dissection techniques of each flap step by step, from vascular anatomy, flap design and elevation to harvest and transfer. The deep circumflex iliac artery dcia provides a dependable option for use as an osteo. Dcia perforator flap, has also been studied for potential use in various reconstructive scenarios. Clinical applications of perforator flap based on superficial circumflex iliac artery suggest that a dominant perforator based on his deep branch is enough to supply a large groin flap.

Anatomy multiple studies have looked at the anatomy of the dcia perforator. Accompanying the book are four supplemental dvds that exhibit exact working procedures. For a centrally located defect, the side with a stronger doppler signal is chosen. Now, even the donor site is a relatively inconsequential consideration. Icg perfusion results, indications, and outcomes of the perforator dcia flap. Surgical atlas of perforator flaps pdf free medical books.

The ultimate technical challenge is presented with chapters on ultrathin perforator flaps and microvascular augmented superthin flaps. Microsurgery information for surgeons, health care professionals and patients, with detailed procedure descritpions. This study defines the anatomical properties of the dcia perforator flap and suggests a dissection algorithm based on these findings. It marks a new era in reconstructive surgery where surgeons are no longer bound by the traditional conventions of flap surgery.

Deep circumflex iliac artery dcia osteocutaneous flap transfer was frequently applied to large defects in the. Flaps in hand and upper limb reconstruction 1st edition. Dcia deep ciicumflex illiac artery perforator flap by. All women who undergo mastectomy are candidates for consideration of perforator flap breast reconstruction when natural tissue reconstruction is preferred over implant reconstruction.

The dcia flap is in the same operative field as the diep, but uses the skin and fat of the love handles. Modifications to flaps based on dcia perforators have been sought to prevent donor site morbidity as. Penn annual flap dissection course penn flap course. Undoubtedly, the most common design when using the rectus abdominis flap is the tram transverse rectus abdominis muscle flap with a horizontal orientation, using the deep inferior epigastric vessels as the pedicle and incorporating the skin from the entire lower abdomen, but many other variations of the skin paddle have been described, such. By combining diep flaps from the front of the abdomen with perforator flaps taken from the flank or love handle area typically deep circumflex iliac artery or dcia flaps, the extended diep flap technique reshapes the. This atlas depicts in a clear manner the use of regional skin, muscle and musculocutaneous flaps as well as donor sites from distant regions of the body where vascularized skin, muscle, bone, and nerves can be harvested and transferred to the head and neck. The groin flap, based on the superficial circumflex iliac artery, was the first successful free flap. This article describes the iliac crest flap, which is based on the deep circumflex iliac artery dcia. Preexpanded perforator flaps, an issue of clinics in plastic. Developments in imageguided deep circumflex iliac artery flap harvest.

Handbook of reconstructive flaps by matthew hanasono and charles butler reflects contributions from clinicians associated with the prestigious md anderson cancer center. Pdf anatomical consideration for the safe elevation of the deep. Profunda artery perforator pap flap for breast reconstruction. Havetanatomical background of the perforator flap based on the deep branch of the superficial circumflex iliac artery scip flap. We present a novel approach to obtaining even more volume by adding another pedicle to the. Flap harvest is possible with patient in the prone position. Perforator flap definition of perforator flap by medical. The aims of this atlas are to introduce the clinical applications of perforator flaps in plastic surgery and skin replacement. For a bilateral breast reconstruction, four flaps can be used, such as bilateral diep and pap flaps or bilateral diep and dcia flaps extended diep or various other combinations of multiple flaps. The propeller flap represents a model of local perforator flap that was first described by hyakusoku et al. The multiplicity of defects needing reconstruction and donorsite morbidity in addition to tailored reconstruction have called for a revision of flap concepts in favor of perforator flaps. Our group successfully performed perforator flap surgery on 17 patients with small to moderate facial defects that affected the functional and aesthetic features of their faces.

Six out of seven patients planned for dcia perforator flap reconstruction underwent a successful dcia perforator flap, with imaging findings confirmed at operation, and without any flap loss, hernia, or other significant flap. When the dcia was transected, the gluteal perforators were dilated bilaterally. Perforator variability in the anterolateral thigh free flap. As a type of plastic surgery, the free flap procedure for breast reconstruction employs tissues, harvested from another part of the womans body, to create a vascularised flap, which is equipped with its own.

A 51yearold female with a history of left breast dcis, bilateral mastectomy and pedicled transverse. Better understanding of vascular anatomy and pattern of skin circulation has become possible by numerous cadaveric studies. Cta can be an essential tool to guide surgeons in harvesting the dcia perforator flap. We prefer a second flap, such as the groin flap, which can be harvested in the same field, often with the same vascular trunk to the groin flap and the dcia flap. The donorsite scar might be more aesthetically objectionable than that of another free flap breast reconstruction technique. Many of the contributors to perforator flaps for breast reconstruction have pioneered the procedures presented in their respective chapters. With its concealed donor site, this flap was especially popular in children and young women.

Perforator flaps have evolved, and they have provided many new flaps with new pedicles all over the body presenting important advantages. Superficial circumflex iliac artery perforator flaps imaging, anatomy and. This is the most common procedure performed at our breast center as women generally have excess skin and fat along the lower portion of their abdomen. The definitive resource on surgical flaps from renowned md anderson plastic surgeons. The deep circumflex iliac artery perforator dciap flap with a cutaneous component overcomes the disadvantages. Since 1983, perforator flaps have, in my mind, run the gamut from exotic local flaps to heroic free flaps to predictable free flaps and finally to ideal local flaps. Neil cahoon, md, josh gillis, md, and rotana fageeh, md. Perforator based propeller flaps in limb reconstructive. Anterior lateral thigh flap perforator, for reconstruction of a subtotal glossectomy. The dcia perforator flap with iliac crest offers a significant skin paddle and bony component perfused by a single vascular pedicle of large diameter. This is usually done if patients do not have adequate skin and tissue in their abdomens, or have had previous abdominal surgeries that may have interfered with blood vessels that the diep flap requires. Perforator flap surgery is a technique used in reconstructive surgery where skin andor subcutaneous fat are removed from a distant or adjacent part of the body to reconstruct the excised part. The side chosen depends on the location of the defects. Clearly, perforator flaps have become an essential element of plastic surgery practice.

Indeed, the profunda artery perforator pap flap, which uses the skin and fat of the posterior thigh, has surpassed the gluteal artery perforator gap flap in our practice as the second line donor site for microsurgical breast reconstruction. Pu and chunmei wang, is devoted to preexpanded perforator flaps. We present the dogear flap, which is an alternative for breast reconstruction in patients who have previously undergone dieap flap reconstruction or abdominoplasty. Otolaryngologists, plastic surgeons and general surgeons use both regional and free flaps to reconstruct damage to the. The perforators, llc opened for business in november of 2004, with two wireline trucks based in roosevelt, utah. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected. The flap can be harvested with or without a skin paddle. In situations when a single deep inferior epigastric perforator diep flap is not an option, we offer an extended diep in conjunction with a deep circumflex iliac artery perforator dcia flap to add more volume to the reconstructed breast. In this model the flap is harvested around a cutaneous perforator arterial branch by twisting of the vascular pedicle and rotating the skin paddle. Advances in autologous breast reconstruction continue to mount and have been fueled most substantially with refinement of perforator flap techniques. This low percentage has been attributed to lack of both information and access. We describe reconstructions with dciap flaps in 3 patients with. The causes for return to the or are listed below in.

In this article, we describe our technique, pearls and pitfalls, and early results. Penn annual flap dissection course penn flap course fresh. A dcia free flap is one way of filling a bony hole in either the upper or lower jaw. This has also caused a corresponding increase in the number of breast. Deltopectoral flap an overview sciencedirect topics. We design the perforator flaps used in this surgery much the same way that cosmetic plastic surgeons design a body lift. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular. If you have any other questions that the leaflet does not answer or would like further explanation please ask. Musculocutaneous perforator flaps offer advantages over musculocutaneous flaps, including reduced donor site morbidity, more predictable reconstruction of soft tissue deformities, and a wider variety of flap options. The editors, leading reconstructive surgeons and pioneers in the field of perforator flap surgery, have assembled a group of worldrenowned experts who discuss perforator anatomy and clinical indications for the use of these flaps. A textbook of advanced oral and maxillofacial surgery. A cost based comparison between perforator flaps and tram. The cutaneous vessels can be mapped out with a handheld pencil doppler probe placed at the midpoint between the anterior superior iliac spine and the superolateral corner of the patella. They often require 2 free flaps or a free scapular flap and both have disadvantages.

The flap is designed as an ellipse so the scar does not extend onto the visible lateral or medial thigh outside of the gluteal fold, being usually 27 cm transversely. There was a 96% success rate with 4% 22 flap failures and 6% 29 partial flap loss. Extended or stacked flap breast reconstruction uses multiple perforator flaps stacked on top of another to create a larger breast. With the report of freestyle free flaps by wei and mardini 20, a new gate has been opened for reconstruction of defects using tissues.

Diepsiea flap breast reconstruction aesthetic plastic. A perforator flap is a flap consisting of skin and subcutaneous tissue that is perfused by an isolated. The in vivo anatomy of the deep circumflex iliac artery. His areas of special interest are flap surgery, lymphatic surgery, facial reanimation and facial transplantation. Introduction the groin flap, nourished by the superficial circumflex iliac artery scia, is historically important because it was the first successful free flap. The first ever international course on perforator flaps icpf was organized in gent, belgium, 20 years ago in 1997, when perforator flap surgery was still in its pioneering phase. An example of free flap could be a free toe transfer in which the great toe or the second toe is transferred to the hand to reconstruct a thumb. Feb 28, 2019 overall, only 1516% of these mastectomy patients undergo reconstruction.

We present the case of a 76yearold woman treated with an osteomyocutaneous dciap flap variant for facial reconstruction. We are very pleased to announce the penn flap course to be held on august 1416, 2020. Superficial circumflex iliac artery perforator flaps imaging, anatomy. Keystone and pedicle perforator flaps in reconstructive. The institution is internationally recognized as one of the worlds premier reconstructive centers and renowned for its reconstructive. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb, and the trunk. The diep flap is the technique where skin and tissue no muscle is taken from the abdomen in order to recreate the breast. For all free flaps, the blood supply is reconstituted using microsurgical techniques to reconnect the artery brings blood into the flap and vein allows blood to flow out of the flap. The latter is described first because the former does not require preservation of cutaneous perforator vessels. The flap is designed with its long axis parallel to the intercostal space in a horizontal. A broad search was undertaken through the pubmed database using the terms anterolateral thigh free flap and perforator.

University of groningen the significance of preoperative. The combined deep inferior epigastric perforator diep dcia flap is most commonly used when the diep flap would provide inadequate volume for breast reconstruction. The vessels that supply blood to the flap are isolated perforator s derived from a deep vascular system through the underlying muscle or intermuscular septa. Pdf perforator flaps in head and neck reconstruction. After a brief introduction of the concept and surgical rationale of perforator flaps, the book presents 24 different flaps from donor sites including upper limb, lower limb and the trunk. The book outlines strategies for flap harvest, from in all probability probably the most main to the extraordinarily superior. It is one of the common ways of replacing bone that has been removed for cancer treatment. During flap surgery, the dominant perforator is usually selected as the pedicle. The dcia flap is a novel technique for breast reconstruction. This study investigated the effect of a nondominant perforator on multiterritory perforator flap survival. Course material will include a program book with dissection guides and. The deep circumflex iliac artery perforator flap dcia flap and intercostal artery perforator flap ica flap were performed n 12. Here, we report a novel, definable, and reproducible ltap flap model. Superficial circumflex iliac artery perforator flap.

Preexpanded perforator flaps, an issue of clinics in plastic surgery authors. The anatomical basis of the deep circumflex iliac artery perforator flap with iliac crest leonard. He is a professor of surgery at uw and director of the center for reconstructive surgery at uwmc. Anatomical background of the perforator flap based on the. The anterolateral thigh flap is the most commonly used perforator flap in head and neck reconstruction.

The deep circumflex iliac artery perforator flap for breast. Case report 1 3 facial reconstruction with a unique osteomyocutaneous dcia perforator flap variant. The plastic surgeons of the new york breast reconstruction associates at aesthetic plastic surgery, pc, perform hundreds of microsurgical free flap breast reconstruction operations every year. The fibula free flap can be harvested as an osseous or osteocutaneous flap. A new lateral thoracic artery perforator flap design with multiple. We are a company that takes pride in the services we provide. Dcia reconstruction phoenix, az flap surgery aesthetic.

The dcia flap is used alone in cases where the anterior abdominal wall has previously been harvested, for example, after a superficial inferior epigastric artery siea, diep, or. Since the first profunda artery perforator pap flap for breast reconstruction, we have had one patient that had an inadequate profunda artery perforator that required a transverse. Purchase flaps in hand and upper limb reconstruction 1st edition. A cost based comparison between perforator flaps and tram flaps for breast reconstruction may 2000 robert j. Many new developments have taken place in the field, including the use of local perforator flaps, including freestyle propeller flaps as well as. One flap included one diep, one siea and one dcia pedicle.

The relationship between scia, dcia and siea was depicted and subdivided into. The percentage of surviving flap area was measured after 7 days with digital. Dciadeep circumflex iliac artery flap british association. The perforator at the second intercostal space is preferred, because it is often larger and closer to the defect. Generally there is a good internal projection of the flap without the need for folding or tucking. Effect of a nondominant perforator on multiterritory. Facial reconstruction with a unique osteomyocutaneous dcia. Freestyle local perforator flaps for facial reconstruction.