J Reconstr Microsurg 2013; 29(01): 045-050
DOI: 10.1055/s-0032-1326738
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intramuscular Perforator Dissection with the Hydrodissection Technique

Dhruv Singhal
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Adeyiza O. Momoh
2   Division of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
,
Salih Colakoglu
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Ali Qureshi
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Adam M. Tobias
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Bernard T. Lee
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

14 February 2012

25 April 2012

Publication Date:
04 October 2012 (online)

Abstract

Background Perforator flap breast reconstruction requires increased time for safe perforator dissection, especially the intramuscular course. We describe an adjunctive technique using hydrodissection to assist with the intramuscular perforator dissection.

Methods Hydrodissection techniques were used for perforator dissection in 45 consecutive patients (64 flaps) undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. These patients were compared with 39 patients (55 flaps) immediately prior to the use of this technique. The study time frame was between March 2008 and March 2010. Patient demographics, complications, and operative times were collected through an extensive chart review.

Results There were no major differences in complications between groups; there were no flap losses encountered during this series, and fat necrosis rates were similar (9.4% with hydrodissection and 14.5% without, p = 0.41). Total operative time for bilateral reconstructions decreased by 59 minutes (p = 0.13) and 21 minutes (p = 0.57) for unilateral reconstructions with the utilization of hydrodissection, though this was not statistically significant.

Conclusions The use of hydrodissection to assist with intramuscular perforator vessel dissection is safe to perform, as there was no increase in complications. The procedures utilizing hydrodissection were faster, and surgeons using this technique found it easier to visualize the perforators and dissect through the intramuscular course.

 
  • References

  • 1 Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg 1994; 32: 32-38
  • 2 Wong C, Saint-Cyr M, Mojallal A , et al. Perforasomes of the DIEP flap: vascular anatomy of the lateral versus medial row perforators and clinical implications. Plast Reconstr Surg 2010; 125: 772-782
  • 3 Cremona G, Carrasco MA. Hydrodissection after nucleus fracture. J Cataract Refract Surg 2000; 26: 1714-1716
  • 4 Fine IH. Cortical cleaving hydrodissection. J Cataract Refract Surg 1992; 18: 508-512
  • 5 Faust KJ. Origin of hydrodissection. J Cataract Refract Surg 1995; 21: 6
  • 6 Levy JH, Pisacano AM, Yalon M. New and efficient hydrodissection cannula to enhance fluid distribution around the nucleus. J Cataract Refract Surg 1994; 20: 478-479
  • 7 Mejia R, Saxena P, Tam RK. Hydrodissection in redo sternotomies. Ann Thorac Surg 2005; 79: 363-364
  • 8 Saxena P, Mejia R, Tam R. Hydrodissection technique of harvesting left internal thoracic artery. Ann Thorac Surg 2005; 80: 355-356
  • 9 Muensterer OJ, Georgeson KE. Multimedia manuscript: inguinal hernia repair by single-incision pediatric endosurgery (SIPES) using the hydrodissection-lasso technique. Surg Endosc 2011; 25: 3438-3439
  • 10 Naude GP, Morris E, Bongard FS. Laparoscopic cholecystectomy facilitated by hydrodissection. J Laparoendosc Adv Surg Tech A 1998; 8: 215-218
  • 11 Luna-Pizarro D, Rodríguez-Cabrera R, Pérez-Hernández J, Moreno-Delgado F. [Result of hydrodissection of the paratendon of the patellar tendon during bone-tendon-bone graft reconstruction of the anterior cruciate ligament]. Cir Cir 2006; 74: 463-468
  • 12 Choi TW, Oh CK. Hydrodissection for complete removal of a ranula. Ear Nose Throat J 2003; 82: 946-947 , 951
  • 13 May J, McGovern F. Hemostatic hydrodissection: a new technique to promote nerve-sparing during radical retropubic prostatectomy. Curr Urol Rep 2005; 6: 1
  • 14 Garusi C, Lohsiriwat V, de Lorenzi F, Manconi A, de Fiori E, Bellomi M. A subfascial variant of the deep inferior epigastric artery demonstrated by preoperative multidetector computed tomographic angiography: a case report. Microsurgery 2010; 30: 156-158
  • 15 Ting J, Rozen WM, Morsi A. Subfascial variants of the deep inferior epigastric artery and its perforators: use the hydrodissection technique. Microsurgery 2010; 30: 249-250
  • 16 Ting J, Rozen WM, Morsi A. Improving the subfascial dissection of perforators during deep inferior epigastric artery perforator flap harvest: the hydrodissection technique. Plast Reconstr Surg 2010; 126: 87e-89e
  • 17 Momoh AO, Colakoglu S, Westvik TS , et al. Analysis of complications and patient satisfaction in pedicled transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flap breast reconstruction. Ann Plast Surg 2011; ; Jun 8 [Epub ahead of print]
  • 18 Garvey PB, Buchel EW, Pockaj BA , et al. DIEP and pedicled TRAM flaps: a comparison of outcomes. Plast Reconstr Surg 2006; 117: 1711-1719 , discussion 1720–1721
  • 19 Hofer SO, Damen TH, Mureau MA, Rakhorst HA, Roche NA. A critical review of perioperative complications in 175 free deep inferior epigastric perforator flap breast reconstructions. Ann Plast Surg 2007; 59: 137-142
  • 20 Blondeel PN. One hundred free DIEP flap breast reconstructions: a personal experience. Br J Plast Surg 1999; 52: 104-111
  • 21 Gill PS, Hunt JP, Guerra AB , et al. A 10-year retrospective review of 758 DIEP flaps for breast reconstruction. Plast Reconstr Surg 2004; 113: 1153-1160
  • 22 Saxena P, Tam R. Papaverine hydrodissection of internal thoracic artery. Asian Cardiovasc Thorac Ann 2007; 15: 542