Charging Fuss

There has been a debate, probably from the very first use of the terms “supercharging” and “turbocharging” to explain microsurgical enhancements of flaps. These terms are said to be inherited from automotive industry. But these modifications were being used for airborne vehicles, nearly five decades before their use in automotives.

Charging means utilizing extra pressurized air, forced into a motor by a compressor unit. The force that powers the compressor unit, defines the type of charging. If exhaust is to be used “turbo,” if a conveyer belt or mechanical driven force is to be used “super” prefix is conjoined.

Having metaphoric names for surgical procedures may seem eccentric. But using a sound nomenclature is a must for science.

We think that the terms “supercharge” and “turbocharge” leads to confusion. These terms were first used for pedicled transverse rectus abdominus myocutaneous (TRAM) flap modifications, yet their definitions vary among researchers. Takayanagi claimed in his article dated 1987 that extended TRAM flaps should be elevated with preservation of superficial epigastric arteries and these should be anastomosed to thoracoacromial, thoracodorsal, or axillary arteries. In 1993 same author suggested that the external pudendal arteries can also be used for anastomosis of TRAM flap and used the term “supercharge” to exemplify this anastomosis.[1] Semple, in his article dated 1993, argued that in pedicled TRAM flaps, to secure viability of zone IV, bilateral deep inferior epigastric (DIE) arteries and veins should be anastomosed as a loop, and defined this alteration as “turbocharging.”[2] His contemporary Berrino defined the same bilateral DIE anastomosis modification as “recharging.” Same author also suggested that, if this looping was to be used in TRAM flaps with a vertical midline scar, the term “parasite TRAM” should be used.[3] Yamamato preferred to use “turbocharge” to define the anastomosis of inferior epigastric arteries to axillary or thoracodorsal arterial system in vertical rectus abdominis myocutaneous flaps.[4] Tseng and colleagues used the nondominant row anastomosis in free TRAM/DIE perforator flaps to enhance the viability of zone III and named this procedure as “turbocharging.”[5]

If the “supercharging” within a flap is defined as an anastomosis to a distant arterial system, than anastomosing thoracic arteries to transverse cervical arteries as in “supercharged” pectoralis major musculocutaneous flaps,[6] or anastomosing distal pedicle of extended forehead flaps to ipsilateral facial arteries as in “supercharged” forehead flaps,[7] are not truly “supercharging” indeed, for the anastomosis is done within same arterial system.

If not, then maybe a different term other than “supercharging” should be used for defining anastomosis of mesenteric artery to internal mamarial artery for distal viability of jejunum flaps as in esophageal reconstructions,[8] or for defining the anastomosis of thoracodorsal pedicle to infragluteal artery in latissimus dorsi musculocutaneous flaps based on nondominant pedicles.[9]

Above else, if “charging” by definition is the usage of an auxiliary unit to enforce a motor, and its counterpart in microsurgery is to arterialize a flap via distant anastomosis, than naming the venous anastomosis as “supercharging” or “turbocharging” is an oxymoron.

It is obvious that the same terms are used to explain different flap modifications. To avoid this confusion we suggest using of the term, “microsurgically augmented flaps” instead of artificial terms as “supercharging” or “turbocharging.” Details of different modifications can be described by authors under this comprehensive term.

• References

• 1 Takayanagi S. Extended transverse rectus abdominis musculocutaneous flap. Plast Reconstr Surg 1993; 92 (4) 757-758
• 2 Semple JL. Retrograde microvascular augmentation (turbocharging) of a single-pedicle TRAM flap through a deep inferior epigastric arterial and venous loop. Plast Reconstr Surg 1994; 93 (1) 109-117
• 3 Berrino P, Casabona F, Adami M, Muggianu M. The “parasite” TRAM flap for autogenous tissue breast reconstruction in patients with vertical midabdominal scars. Ann Plast Surg 1999; 43 (2) 119-126
• 4 Yamamoto Y, Nohira K, Shintomi Y, Sugihara T, Ohura T. “Turbo charging” the vertical rectus abdominis myocutaneous (turbo-VRAM) flap for reconstruction of extensive chest wall defects. Br J Plast Surg 1994; 47 (2) 103-107
• 5 Tseng CY, Lang PO, Cipriani NA, Song DH. Pedicle preservation technique for arterial and venous turbocharging of free DIEP and muscle-sparing TRAM flaps. Plast Reconstr Surg 2007; 120 (4) 851-854
• 6 Makiguchi T, Yokoo S, Miyazaki H , et al. Supercharged pectoralis major musculocutaneous flap. J Craniofac Surg 2013; 24 (2) e179-e182
• 7 Gan C, Fan J, Liu L , et al. Reconstruction of large unilateral hemi-facial scar contractures with supercharged expanded forehead flaps based on the anterofrontal superficial temporal vessels. J Plast Reconstr Aesthet Surg 2013; 66 (11) 1470-1476
• 8 Barzin A, Norton JA, Whyte R, Lee GK. Supercharged jejunum flap for total esophageal reconstruction: single-surgeon 3-year experience and outcomes analysis. Plast Reconstr Surg 2011; 127 (1) 173-180
• 9 Cigna E, Mardini S, Chen HC , et al. An improved method of supercharged transposed latissimus dorsi flap with the skin paddle for the management of a complicated lumbosacral defect. Eur Rev Med Pharmacol Sci 2015; 19 (6) 921-926