TY - JOUR
T1 - Rib-sparing internal mammary vessel harvest for microvascular breast reconstruction in 100 consecutive cases
AU - Sacks, Justin M.
AU - Chang, David W.
PY - 2009/5/1
Y1 - 2009/5/1
N2 - BACKGROUND: Using the internal mammary vessels as recipient vessels in free-flap autologous breast reconstruction has become a common practice. However, these vessels are typically accessed by removing a costochondral segment. The purpose of this study was to describe the authors' rib-sparing technique for accessing the internal mammary vessels that is efficient and reliable and limits chest wall morbidity. METHODS: The authors analyzed 100 consecutive free-tissue transfers for breast reconstruction in which the internal mammary vessels were accessed using a rib-sparing technique. The data were obtained from a prospectively maintained database and medical records. RESULTS: Of the 100 free-flap reconstructions, 47 used deep inferior epigastric perforator flaps, 45 used muscle-sparing transverse rectus abdominis myocutaneous flaps, six used superficial inferior epigastric artery flaps, and two used superior gluteal artery perforator flaps. No rib cartilage was removed in 66, but a segment of rib cartilage was removed in 34 procedures to optimize the exposure and facilitate anastomosis. After the initial learning curve, however, the internal mammary vessels were used in approximately 90 percent of cases without removal of any rib cartilage. The third intercostal space was used to access the internal mammary vessels two-thirds of the time, and the second intercostal space was used one-third of the time. There were no incidences of complications or morbidity associated with the rib-sparing approach to internal mammary vessel harvest. CONCLUSION: For most patients, the rib-sparing technique is an efficient and safe approach for exposing the internal mammary vasculature for microvascular breast reconstruction while minimizing chest wall morbidity.
AB - BACKGROUND: Using the internal mammary vessels as recipient vessels in free-flap autologous breast reconstruction has become a common practice. However, these vessels are typically accessed by removing a costochondral segment. The purpose of this study was to describe the authors' rib-sparing technique for accessing the internal mammary vessels that is efficient and reliable and limits chest wall morbidity. METHODS: The authors analyzed 100 consecutive free-tissue transfers for breast reconstruction in which the internal mammary vessels were accessed using a rib-sparing technique. The data were obtained from a prospectively maintained database and medical records. RESULTS: Of the 100 free-flap reconstructions, 47 used deep inferior epigastric perforator flaps, 45 used muscle-sparing transverse rectus abdominis myocutaneous flaps, six used superficial inferior epigastric artery flaps, and two used superior gluteal artery perforator flaps. No rib cartilage was removed in 66, but a segment of rib cartilage was removed in 34 procedures to optimize the exposure and facilitate anastomosis. After the initial learning curve, however, the internal mammary vessels were used in approximately 90 percent of cases without removal of any rib cartilage. The third intercostal space was used to access the internal mammary vessels two-thirds of the time, and the second intercostal space was used one-third of the time. There were no incidences of complications or morbidity associated with the rib-sparing approach to internal mammary vessel harvest. CONCLUSION: For most patients, the rib-sparing technique is an efficient and safe approach for exposing the internal mammary vasculature for microvascular breast reconstruction while minimizing chest wall morbidity.
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U2 - 10.1097/PRS.0b013e3181a07249
DO - 10.1097/PRS.0b013e3181a07249
M3 - Article
C2 - 19407609
AN - SCOPUS:66549089471
SN - 0032-1052
VL - 123
SP - 1403
EP - 1407
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 5
ER -