Muss es immer das Abdomen sein? – Alternative Lappen zur mikrochirurgischen Brustrekonstruktion

Zusammenfassung

Die DIEP- (Deep inferior epigastric Perforator) oder muskelsparende transverse Rectus-abdominis-Myokutan-Lappenplastik (ms-TRAM) gilt als Gold-Standard in der autologen Brustrekonstruktion bei post-Mastektomie Patientinnen. Einige Patientinnen sind aus verschiedenen Gründen keine geeigneten Kandidatinnen für eine Gewebeentnahme am Bauch. In diesen Fällen stehen diverse andere Hebestellen am Oberschenkel (transverse und diagonale myokutane musculus gracilis Lappenplastik, profunda artery perforator Lappenplastik, lateral thigh perforator Lappenplastik), am Stamm (Lumbalarterienperforator-Lappenplastik) und aus der Gesäßregion (superiore und inferiore Glutealarterien und fasziokutane infragluteale Lappenplastik) zu Verfügung. Dieser Artikel gibt einige Einblicke in die Historie, die relevante Anatomie, die chirurgische Technik und neue Anwendungen wie die Neurotisation alternativer Lappenplastiken zur autologen Brustrekonstruktion.

Abstract

[English] Deep inferior epigastric artery perforator (DIEP) or muscle-sparing transverse rectus abdominis muscle (ms-TRAM) flaps remain the gold standard for autologous reconstruction in post-mastectomy patients, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap), trunk (lumbar artery perforator flap), and buttock (superior and inferior gluteal artery perforator flaps). This article will provide insight into the history, relevant anatomy, surgical technique and novel applications (neurotization) for alternative flaps in autologous breast reconstruction.

Schlüsselwörter

Mikrochirurgie - autologe Brustrekonstruktion - TMG-Lappen - PAP-Lappen - LAP-Lappen - S-GAP-Lappen - I-GAP-Lappen - FCI-Lappen - LTP-Lappen

Key words

microsurgery - autologous breast reconstruction - TMG flap - PAP flap - LAP flap - S-GAP flap - I-GAP flap - FCI flap - LTP flap

Publication History

Received: 29 December 2021

Accepted: 16 May 2022

Article published online:
09 August 2022

• Literatur

• 1 Cederna PS, Yates WR, Chang P. et al. Postmastectomy reconstruction: comparative analysis of the psychosocial, functional, and cosmetic effects of transverse rectus abdominis musculocutaneous flap versus breast implant reconstruction. Annals of plastic surgery 1995; 35: 458-468 DOI: 10.1097/00000637-199511000-00003.
• 2 Hu ES, Pusic AL, Waljee JF. et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Period. Plastic and reconstructive surgery 2009; 124: 1-8 DOI: 10.1097/PRS.0b013e3181ab10b2.
• 3 Ng SK, Hare RM, Kuang RJ. et al. Breast Reconstruction Post Mastectomy: Patient Satisfaction and Decision Making. Annals of plastic surgery 2016; 76: 640-644 DOI: 10.1097/sap.0000000000000242.
• 4 Cai A, Suckau J, Arkudas A. et al. Autologous Breast Reconstruction with Transverse Rectus Abdominis Musculocutaneous (TRAM) or Deep Inferior Epigastric Perforator (DIEP) Flaps: An Analysis of the 100 Most Cited Articles. Medical science monitor: international medical journal of experimental and clinical research 2019; 25: 3520-3536 DOI: 10.12659/msm.914665.
• 5 Fansa H, Schirmer S, Warnecke IC. et al. The transverse myocutaneous gracilis muscle flap: a fast and reliable method for breast reconstruction. Plastic and reconstructive surgery 2008; 122: 1326-1333 DOI: 10.1097/PRS.0b013e318188205f.
• 6 Schoeller T, Huemer GM, Wechselberger G. The transverse musculocutaneous gracilis flap for breast reconstruction: guidelines for flap and patient selection. Plastic and reconstructive surgery 2008; 122: 29-38 DOI: 10.1097/PRS.0b013e318177436c.
• 7 Yousif NJ, Matloub HS, Kolachalam R. et al. The transverse gracilis musculocutaneous flap. Annals of plastic surgery 1992; 29: 482-490 DOI: 10.1097/00000637-199212000-00002.
• 8 Locke MB, Zhong T, Mureau MA. et al. Tug ‘O’ war: challenges of transverse upper gracilis (TUG) myocutaneous free flap breast reconstruction. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2012; 65: 1041-1050 DOI: 10.1016/j.bjps.2012.02.020.
• 9 Vega SJ, Sandeen SN, Bossert RP. et al. Gracilis myocutaneous free flap in autologous breast reconstruction. Plastic and reconstructive surgery 2009; 124: 1400-1409 DOI: 10.1097/PRS.0b013e3181babb19.
• 10 Deutinger M, Kuzbari R, Paternostro-Sluga T. et al. Donor-site morbidity of the gracilis flap. Plastic and reconstructive surgery 1995; 95: 1240-1244 DOI: 10.1097/00006534-199506000-00015.
• 11 Buntic RF, Horton KM, Brooks D. et al. Transverse upper gracilis flap as an alternative to abdominal tissue breast reconstruction: technique and modifications. Plastic and reconstructive surgery 2011; 128: 607e-613e DOI: 10.1097/PRS.0b013e318230c2b6.
• 12 Spiegel AJ, Menn ZK, Eldor L. et al. Breast Reinnervation: DIEP Neurotization Using the Third Anterior Intercostal Nerve. Plastic and reconstructive surgery Global open 2013; 1: e72 DOI: 10.1097/gox.0000000000000008.
• 13 Beugels J, Cornelissen AJM, van Kuijk SMJ. et al. Sensory Recovery of the Breast following Innervated and Noninnervated DIEP Flap Breast Reconstruction. Plastic and reconstructive surgery 2019; 144: 178e-188e DOI: 10.1097/prs.0000000000005802.
• 14 Gatherwright J, Knackstedt R, Kurlander D. et al. Anatomic location of a sensory nerve to the transverse upper gracilis (TUG) flap: A novel option for sensate autologous tissue reconstruction. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2019; 72: 137-171 DOI: 10.1016/j.bjps.2018.09.013.
• 15 Akdeniz Dogan Z, Farhadi J. Evaluation of Sensation on Mastectomy Skin Flaps following Immediate Breast Reconstruction. Journal of reconstructive microsurgery 2020; 36: 420-425 DOI: 10.1055/s-0040-1702157.
• 16 Khan A, Zhang J, Sollazzo V. et al. Sensory change of the reconstructed breast envelope after skin-sparing mastectomy. European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 2016; 42: 973-979 DOI: 10.1016/j.ejso.2016.03.018.
• 17 Tevlin R, Brazio P, Tran N. et al. Immediate targeted nipple-areolar complex re-innervation: Improving outcomes in immediate autologous breast reconstruction. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2021; 74: 1503-1507 DOI: 10.1016/j.bjps.2020.11.021.
• 18 Dayan E, Mark L, Smith MS, Samson W, Joseph H. Dayan The Diagonal Upper Gracilis (DUG) Flap A Safe and Improved Alternative to the TUG Flap. Plastic and reconstructive surgery 2013; 132: 33-34
• 19 Myers PL, Nelson JA, Allen RJ. Alternative flaps in autologous breast reconstruction. Gland surgery 2021; 10: 444-459 DOI: 10.21037/gs.2020.03.16.
• 20 Dayan JH, Allen RJ. Neurotized Diagonal Profunda Artery Perforator Flaps for Breast Reconstruction. Plastic and reconstructive surgery Global open 2019; 7: e2463 DOI: 10.1097/gox.0000000000002463.
• 21 Dayan JH, Allen RJ. Lower Extremity Free Flaps for Breast Reconstruction. Plastic and reconstructive surgery 2017; 140: 77s-86s DOI: 10.1097/prs.0000000000003944.
• 22 Allen RJ, Haddock NT, Ahn CY. et al. Breast reconstruction with the profunda artery perforator flap. Plastic and reconstructive surgery 2012; 129: 16e-23e DOI: 10.1097/PRS.0b013e3182363d9f.
• 23 Allen RJ, Lee ZH, Mayo JL. et al. The Profunda Artery Perforator Flap Experience for Breast Reconstruction. Plastic and reconstructive surgery 2016; 138: 968-975 DOI: 10.1097/prs.0000000000002619.
• 24 Hunter JE, Lardi AM, Dower DR. et al. Evolution from the TUG to PAP flap for breast reconstruction: Comparison and refinements of technique. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2015; 68: 960-965 DOI: 10.1016/j.bjps.2015.03.011.
• 25 Hurwitz DJ, Walton RL. Closure of chronic wounds of the perineal and sacral regions using the gluteal thigh flap. Annals of plastic surgery 1982; 8: 375-386 DOI: 10.1097/00000637-198205000-00004.
• 26 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. British journal of plastic surgery 1984; 37: 149-159 DOI: 10.1016/0007-1226(84)90002-x.
• 27 Haddock NT, Gassman A, Cho MJ. et al. 101 Consecutive Profunda Artery Perforator Flaps in Breast Reconstruction: Lessons Learned with Our Early Experience. Plastic and reconstructive surgery 2017; 140: 229-239 DOI: 10.1097/prs.0000000000003553.
• 28 Qian B, Xiong L, Li J. et al. A Systematic Review and Meta-Analysis on Microsurgical Safety and Efficacy of Profunda Artery Perforator Flap in Breast Reconstruction. Journal of oncology 2019; 2019: 9506720 DOI: 10.1155/2019/9506720.
• 29 Haddock NT, Suszynski TM, Teotia SS. Consecutive Bilateral Breast Reconstruction Using Stacked Abdominally Based and Posterior Thigh Free Flaps. Plastic and reconstructive surgery 2021; 147: 294-303 DOI: 10.1097/prs.0000000000007548.
• 30 Allen RJ, Tucker C. Superior gluteal artery perforator free flap for breast reconstruction. Plastic and reconstructive surgery 1995; 95: 1207-1212 DOI: 10.1097/00006534-199506000-00010.
• 31 Healy C, Allen RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. Journal of reconstructive microsurgery 2014; 30: 121-125 DOI: 10.1055/s-0033-1357272.
• 32 Blondeel PN. The sensate free superior gluteal artery perforator (S-GAP) flap: a valuable alternative in autologous breast reconstruction. British journal of plastic surgery 1999; 52: 185-193 DOI: 10.1054/bjps.1998.3032.
• 33 Beier JP, Horch RE, Bach AD. Breast reconstruction after breast-cancer surgery. The New England journal of medicine 2009; 360: 418-419 author reply 420-411 DOI: 10.1056/NEJMc082264.
• 34 Guerra AB, Metzinger SE, Bidros RS. et al. Breast reconstruction with gluteal artery perforator (GAP) flaps: a critical analysis of 142 cases. Annals of plastic surgery 2004; 52: 118-125 DOI: 10.1097/01.sap.0000095437.43805.d1.
• 35 Godbout E, Farmer L, Bortoluzzi P. et al. Donor-site morbidity of the inferior gluteal artery perforator flap for breast reconstruction in teenagers. The Canadian journal of plastic surgery=Journal canadien de chirurgie plastique 2013; 21: 19-22 DOI: 10.1177/229255031302100110.
• 36 Knackstedt R, Gatherwright J, Drake R. et al. Anatomic location of sensory nerves to the superior and inferior gluteal artery perforators flap: Novel option for sensate autologous tissue reconstruction. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2019; 72: 1576-1606 DOI: 10.1016/j.bjps.2019.05.020.
• 37 Papp C, Windhofer C, Gruber S. Breast reconstruction with the fasciocutaneous infragluteal free flap (FCI). Annals of plastic surgery 2007; 58: 131-136 DOI: 10.1097/01.sap.0000237635.05337.a1.
• 38 Struckmann V, Peek A, Wingenbach O. et al. The free fasciocutaneous infragluteal (FCI) flap: Outcome and patient satisfaction after 142 breast reconstructions. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2016; 69: 461-469 DOI: 10.1016/j.bjps.2015.12.010.
• 39 Papp C, Wechselberger G, Schoeller T. Autologous breast reconstruction after breast-conserving cancer surgery. Plastic and reconstructive surgery 1998; 102: 1932-1936 discussion 1937-1938 DOI: 10.1097/00006534-199811000-00018.
• 40 Hill HL, Nahai F, Vasconez LO. The tensor fascia lata myocutaneous free flap. Plastic and reconstructive surgery 1978; 61: 517-522 DOI: 10.1097/00006534-197804000-00004.
• 41 Nahai F, Silverton JS, Hill HL. et al. The tensor fascia lata musculocutaneous flap. Annals of plastic surgery 1978; 1: 372-379 DOI: 10.1097/00000637-197807000-00003.
• 42 Elliott LF, Beegle PH, Hartrampf CR. The lateral transverse thigh free flap: an alternative for autogenous-tissue breast reconstruction. Plastic and reconstructive surgery 1990; 85: 169-178 discussion 179-181
• 43 Kind GM, Foster RD. Breast reconstruction using the lateral femoral circumflex artery perforator flap. Journal of reconstructive microsurgery 2011; 27: 427-432 DOI: 10.1055/s-0031-1281527.
• 44 Boehm D, Bergmeister K, Gazyakan E. et al. Autologous Breast Reconstruction Using a Tensor Fascia Lata/Anterior Lateral Thigh-Freestyle Flap After Extensive Electric Burn: A Case Report. Annals of plastic surgery 2018; 80: 503-506 DOI: 10.1097/sap.0000000000001429.
• 45 Tuinder SMH, Beugels J, Lataster A. et al. The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps. Plastic and reconstructive surgery 2018; 141: 257-268 DOI: 10.1097/prs.0000000000004072.
• 46 Knackstedt R, Djohan R, Gatherwright J. Anatomic location of a sensory nerve to the lateral thigh flap: A novel option for sensate autologous tissue reconstruction. Journal of plastic, reconstructive & aesthetic surgery: JPRAS 2019; 72: 513-527 DOI: 10.1016/j.bjps.2018.12.015.
• 47 de Weerd L, Elvenes OP, Strandenes E. et al. Autologous breast reconstruction with a free lumbar artery perforator flap. British journal of plastic surgery 2003; 56: 180-183 DOI: 10.1016/s0007-1226(03)00039-0.
• 48 Opsomer D, Stillaert F, Blondeel P. et al. The Lumbar Artery Perforator Flap in Autologous Breast Reconstruction: Initial Experience with 100 Cases. Plastic and reconstructive surgery 2018; 142: 1e-8e DOI: 10.1097/prs.0000000000004522.
• 49 Haddock NT, Teotia SS. Lumbar Artery Perforator Flap: Initial Experience with Simultaneous Bilateral Flaps for Breast Reconstruction. Plastic and reconstructive surgery Global open 2020; 8: e2800 DOI: 10.1097/gox.0000000000002800.
• 50 Kato H, Hasegawa M, Takada T. et al. The lumbar artery perforator based island flap: anatomical study and case reports. British journal of plastic surgery 1999; 52: 541-546 DOI: 10.1054/bjps.1999.3120.