Superficial Inferior Epigastric Research Articles

The anatomy of the superficial inferior epigastric artery: Cautious optimism and rightful reluctance for the championing of a minimally morbid abdominal flap

The Superficial Inferior Epigastric Artery (SIEA) flap has gained interest due to its potential as an abdominal breast reconstruction flap that incurs minimal donor site morbidity. Historical descriptions of its anatomy however paint the artery as small in calibre, with a restrictive angiosome and a high agenesis rate. This review examines the most contemporary anatomical data of the SIEA across clinical, cadaver and radiological modalities and balances the promise of encouraging anatomical data against the clinical practicalities of consistently and safely raising an SIEA flap.

Confusion Regarding the Anatomy of the Superficial Inferior Epigastric Artery and the Superficial Circumflex Iliac Artery Superficial Branch.

Confusion Regarding the Anatomy of the Superficial Inferior Epigastric Artery and the Superficial Circumflex Iliac Artery Superficial Branch.

Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline.

Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of lower donor site morbidity over other abdominal-based flaps for breast reconstruction. However, the inconsistent anatomy and territory across the midline remains a major issue. This study aimed to investigate the SIEA and determine its pattern and territory across the midline. Twenty cadavers were studied. Ipsilateral dye was injected to the dominant SIEA. Dissection was performed to evaluate the SIEA origin, artery and vein pattern, vessel diameter, and dye diffusion territory. Overall, three SIEA patterns were identified: bilateral presence (45%), ipsilateral presence (30%), and bilateral absence (25%). The territory depended on the vessel course and dominant SIEA diameter, not on its common origin from the femoral artery, at the pubic tubercle level. Regarding the midline territory (pubic tubercle level to umbilicus), SIEA (type 1a) with a diameter of ≥1.4 mm on either side supplied at least half the distance, whereas SIEA with a diameter of <1 mm was limited to the suprapubic area. Designing a SIEA flap island across the midline is feasible when contralateral SIEA is present to augment the contralateral territory (e.g., type 1a SIEA) or in SIEA with a common/superficial external pudendal artery origin. Preoperative imaging studies are important for confirming the SIEA system. When the diameter at the origin of the SIEA flap is larger than 1.4 mm, the blood supply to the ipsilateral and contralateral sides is sufficient to enable safe flap elevation.

Supercharging DIEP Flaps Using Contralateral Superficial Inferior Epigastric Vein Grafts

Introduction: Venous congestion, even with a patent deep venous anastomosis, can afflict some DIEP (Deep Inferior Epigastric Perforator) flaps and various techniques of superficial venous supercharging have been described, although the indications for its use are not consensual. The main goal of this study is to confirm that superficial venous supercharge of DIEP flaps, utilizing the contralateral Superficial Inferior Epigastric Vein (SIEV) as an interposition vein graft, is feasible and functional. Materials and Methods: We retrospectively reviewed all DIEP flap breast reconstruction patients treated at our institution between June 2016 and December 2017 and that met all the inclusion criteria: Unilateral breast reconstruction with a DIEP flap; flap weighing more than 750 gm; supercharging of the ipsilateral superficial venous system; contralateral SIEV interposition graft; implantable doppler probe in the superficial system for at least 5 days. In the technique described here, the contralateral SIEV graft was harvested and anastomosed to the ipsilateral SIEV, obtaining this way a long vein that easily reaches the recipient vein (distal end of the Internal Mammary Vein - IMV). A Doppler probe was implanted in the superficial system, for at least 5 postoperative days, to monitor the function of this supercharging. We also analyzed the patient’s history, flaps weight, number and perforator rows, recipient vessels, SIEV graft length and diameter and all perioperative complications. Results: Ten patients met all inclusion criteria. They were treated using this technique and analyzed. Two patients had some type of alteration of the Doppler signal and clinical signs of venous congestion. They were surgically revised with success and were analyzed in detail. No total or partial flap failures were found. Clinical fat necrosis was also absent. Conclusion: This technique seems to be feasible, functional and adds an extra length to ipsilateral SIEV to reach a recipient vein. This way, the flap inset is not compromised by a short SIEV. No further significant morbidity is added for SIEV harvest that is in the same operative field, unlike the saphenous or cephalic veins. In selected patients, it could be an alternative supercharging technique.

Increased Production of Abdominal Donor Site Fluid Following Microsurgical Breast Reconstruction With Superficial Inferior Epigastric Artery Versus Deep Inferior Epigastric Artery Perforator Flaps.

Introduction and aims Donor site seroma following abdominal flap harvest for breast reconstruction is common in both deep inferior epigastric artery perforator (DIEP) and superficial inferior epigastric artery (SIEA) flaps. We tested the hypothesis that there is increased donor site fluid following SIEA dissection compared to DIEP. Materials and methods Of60 SIEA breast reconstructions performed by one surgeon in 50 patients (2004-2019), complete data were available for 31 patients. Eighteen unilateral SIEAs were matched with 18 unilateral DIEPs. Thirteen bilateral flap harvests involving an SIEA were matched with 13 bilateral DIEP controls. Their cumulative abdominal drain outputs, times to drain removal, hospital stay, and number and volume of seroma aspirations were compared. Results Patients who underwent an SIEA flap harvest had significantly increased drain output compared to only a DIEP flap harvest (SIEA=1,078 mL, DIEP=500 mL, p<0.001), which remained significant after controlling for confounding variables (p=0.002). There was increased time until drain removal (SIEA=11 days, DIEP=6 days, p=0.010), and patients who underwent an SIEA harvest were 14 times more likely to be discharged with a drain in situ (odds ratio (OR)=14.6, 95% confidence interval (CI)=2.8203-75.9565, p=0.0014). There was no significant difference in the number or volume of outpatient aspirations, length of hospital admission, or total seroma volume. Conclusion This study demonstrated that SIEA harvest is a significant predictor of increased abdominal drain output postoperatively. This accounted for longer periods before drain removal and more patients discharged with an abdominal drain in situ and should be an important consideration for reconstructive surgeons. There was no demonstrable difference in the number or volume of seroma aspirations after drain removal for either group.

Rat Perforator and Skin Vessels Vascular Mapping: An Original Anatomical Study About 140 Vessels and Literature Review

IntroductionRecent microsurgical reconstruction techniques benefit from the use of skin and perforator flaps that spare the donor sites. Studies on these skin flaps in rat models are numerous but there is currently no reference regarding the position of the perforators, their caliber, and the length of the vascular pedicles. MethodsWe performed an anatomical study on 10 Wistar rats and 140 vessels: cranial epigastric (CE), superficial inferior epigastric (SIE), lateral thoracic (LT), posterior thigh (PT), deep iliac circumflex (DCI) and posterior intercostal (PIC) vessels. The evaluation criteria were the external caliber, the length of the pedicle, and the position of the vessels reported on the skin surface. ResultsData from the six perforator vascular pedicles are reported, with figures illustrating the orthonormal reference frame, the representation of the vessel's position, the cloud of points corresponding to the various measurements, and the average representation of the collected data. The analysis of the literature does not find similar studies; the different vascular pedicles are discussed as well as the limitations of our study: evaluation of cadaver specimen, presence of the very mobile panniculus carnosus, other perforator vessels not evaluated as well as the precise definition of perforating vessels. ConclusionsOur work describes the vascular calibers, pedicle lengths, and location of birth and arrival at the skin of the perforator vessels PT, DCI, PIC, LT, SIE, and CE in rat animal models. This work, without an equivalent in the literature, lays the foundation for future studies about flap perfusion, microsurgery, and super microsurgery learning.

The Superficial Inferior Epigastric Artery Axial Flap to Study Ischemic Preconditioning Effects in a Rat Model.

Fasciocutaneous flaps (FCF) have become the gold standard for complex defect reconstruction in plastic and reconstructive surgery. This muscle-sparing technique allows transferring vascularized tissues to cover any large defect. FCF can be used as pedicled flaps or as free flaps; however, in the literature, failure rates for pedicled FCF and free FCF are above 5%, leaving room for improvement for these techniques and further knowledge expansion in this area. Ischemic preconditioning (I.P.) has been widely studied, but the mechanisms and the optimization of the I.P. regimen are yet to be determined. This phenomenon is indeed poorly explored in plastic and reconstructive surgery. Here, a surgical model is presented to study the I.P. regimen in a rat axial fasciocutaneous flap model, describing how to safely and reliably assess the effects of I.P. on flap survival. This article describes the complete surgical procedure, including suggestions to improve the reliability of this model. The objective is to provide researchers with a reproducible and reliable model to test various ischemic preconditioning regimens and assess their effects on flap survivability.

Maximizing the Versatility of Thin Flap from the Groin Area as a Workhorse Flap: The Selective Use of Superficial Circumflex Iliac Artery Perforator (SCIP) Free Flap and Superficial Inferior Epigastric Artery (SIEA) Free Flap with Precise Preoperative Planning.

This study aimed to evaluate the usefulness of the selective use of the superficial circumflex iliac artery perforator (SCIP) and the superficial inferior epigastric artery (SIEA) flap as a workhorse flap from the groin area with precise preoperative surgical planning. A total of 79 free flap reconstructions were performed in the study period; 35 SCIP free flaps and 19 SIEA free flaps were performed in the study period. Detailed preoperative surgical planning was performed using computed tomography (CT) angiography and color Doppler ultrasound. Detailed anatomical information of the flaps and reconstructive outcomes were evaluated. Flap characteristics between SCIP free flaps and SIEA free flaps were similar. The average transverse distance of the perforator from anterior superior iliac spine was 15.91 cm in SCIP free flaps and 43.15 cm in SIEA free flaps. The overall flap success rate was 96.4%. Majority of the patients achieved satisfactory contour without debulking surgery. Donor site morbidity was minimal with one case of wound dehiscence. The selective use of the SCIP and SIEA free flap in groin area is a safe and useful technique. The surgical outcomes were reliable and similar between the SCIP and SIEA free flaps. Preoperative vascular planning using CT angiography and color Doppler ultrasound is essential for selecting the proper flap.

The Anatomic Features and Role of Superficial Inferior Epigastric Vein in Abdominal Flap.

In lower abdominal flap representing transverse rectus abdominis musculocutaneous (TRAM) flap or deep inferior epigastric perforator (DIEP) flap, superficial inferior epigastric vein (SIEV) exists as superficial and independent venous system from deep system. The superficial venous drainage is dominant despite a dominant deep arterial supply in anterior abdominal wall. As TRAM or DIEP flaps began to be widely used for breast reconstruction, venous congestion issue has been arisen. Many clinical series in regard to venous congestion despite patent microvascular anastomosis site were reported. Venous congestion could be divided in two conditions by the area of venous congestion and each condition is from different anatomical causes. First, if venous congestion was shown in whole flap, it is due to the connection between SIEV and vena comitantes of DIEP. Second, if venous congestion is limited in above midline (Hartrampf zone II), it is due to problem in venous midline crossover. In this article, the authors reviewed the role of SIEV in lower abdominal flap based on the various anatomic and clinical studies. The contents are mainly categorized into four main issues; basic anatomy of SIEV, the two cause of venous congestion, connection between SIEV and vena comitantes of DIEP, and midline crossover of SIEV.

Surgical Delay-Induced Hemodynamic Alterations of the Superficial Inferior Epigastric Artery Flap for Autologous Breast Reconstruction.

The superficial inferior epigastric artery (SIEA) flap allows transfer of tissue without violating the rectus fascia. Traditionally it is best used in single stage reconstruction when vessel caliber is 1.5 mm; 56% to 70% of SIEAs are less than 1.5 mm and, therefore, not reliable. We aim to demonstrate the increased reliability of SIEA through surgical delay by quantifying reconstructive outcomes and delay-induced hemodynamic alterations. Patients presenting for autologous breast reconstruction between May 2019 and October 2020 were evaluated with preoperative imaging and received either delayed SIEA or delayed deep inferior epigastric (DIEP) reconstruction based on clinical considerations, such as prior surgery and perforator size/location. Prospective data were collected on operative time, length of stay, and complications. Arterial diameter and peak flow were quantified with Doppler ultrasound predelay and postdelay. Seventeen delayed SIEA flaps were included. The mean age (± SD) was 46.2 ± 10.55 years, and body mass index was 26.7 ± 4.26 kg/m2. Average hospital stay after delay was 0.85 ± 0.90 days, and duration before reconstruction was 6 days to 14.5 months. Delay complications included 1 abdominal seroma (n = 1, 7.7%). Superficial inferior epigastric artery diameter predelay (mean ± 95% confidence interval) was 1.37 ± 0.20 mm and increased to 2.26 ± 0.24 mm postdelay. A significant increase in diameter was noted 0.9 ± 0.22 mm (P < 0.0001). Mean peak flow predelay was 14.43 ± 13.38 cm/s and 44.61 ± 60.35 cm/s (n = 4, P = 0.1822) postdelay. Surgical delay of the SIEA flap augments SIEA diameter, increasing the reliability of this flap for breast reconstruction. Superficial inferior epigastric artery delay results in low rates of complications and no failures in our series. Although more patients are needed to assess increase in arterial flow, use of surgical delay can expand the use of SIEA flap reconstruction and reduce abdominal morbidity associated with abdominal flap breast reconstruction.

Antitumor Immunity from Abdominal Flap-Embedded Therapeutic Cancer Vaccine.

BackgroundAbdominal flaps are routinely performed in clinic after primary mastectomy of breast cancer. However, cancer patients can still develop cancer recurrence and metastasis after surgery. In this study, we evaluated the feasibility of concurrent abdominal flap reconstruction and vaccine inoculation in the tissue for prevention and treatment of HER2-positive breast cancer.MethodsA murine model of metastatic HER2-positive breast cancer was generated by inoculating HER2-expressing TUBO tumor cells into both the mammary gland fat pad and left ventricle. Mammary gland fat pad with primary tumor was resected by mastectomy, and superficial inferior epigastric (SIE) vessel-based abdominal flap was performed for abdominal reconstruction. During the surgery, mice also received a single intra-flap treatment of a microparticulate-based cancer vaccine. Popliteal (Pop) and inguinal (Ing) lymph nodes (LN) were collected at different time points after vaccination, and activation of dendritic cells and T lymphocytes was evaluated with flow cytometry. ELISpot was also performed to measure HER2-specific T cells in splenocytes. In addition, infiltration of CD3+ T cells in brain metastatic nodules was analyzed with immunohistochemistry.ResultsFlow cytometry detected increased number of activated dendritic cells in lymph nodes in mice treated with cancer vaccine. ELISpot revealed abundant IFN-γ-expressing T cells in the spleen. Mice treated with abdominal flap-embedded cancer vaccine extended median survival by 9 days over the control group (p<0.05).ConclusionAbdominal flap-embedded cancer vaccine effectively stimulated systemic immune response and inhibited tumor progression in a murine model of HER2-positive breast cancer.

Novel Classification of the Branching Patterns of the Superficial Branch and the Deep Branch of the Superficial Circumflex Iliac Artery and the Superficial Inferior Epigastric Artery on Computed Tomographic Angiography.

Recent advances in the superficial circumflex iliac artery (SCIA) perforator flap transfer emphasized the necessity to comprehensively understand the lower abdominal vasculature. This study aimed to clarify the relationship among the superficial inferior epigastric artery (SIEA), the superficial branch (SCIAs), and the deep branch (SCIAd) of the SCIA. Computed tomographic angiography was retrospectively reviewed in 312 hemiabdomens in 161 female patients who underwent abdominal flap breast reconstruction. We assessed the presence, caliber, and branching patterns of the SCIA branches and the SIEA. The SIEA-SCIA common trunk was present in 40.1% of the hemiabdomen and was identified in either side of the abdomen in 63.6% of patients. At least one superficial vessel larger than 1.5 mm was found in 61.5% of hemiabdomens. Seven branching patterns of the SCIA-SIEA system were noted: (1) the SCIA and the SIEA originated together (17.0%); (2) the SIEA and the SCIAs shared an origin (22.8%), (3) the SCIA and the SIEA branched separately (17.0%), (4) each artery originated separately (8.0%); (5) the SCIAs and the SCIAd emerged together with the SIEA absent (17.3%); (6) the SCIAs and the SCIAd originated separately with the SIEA absent (13.1%); (7) the SIEA and SCIAd originated separately with the SCIAs absent (3.5%). SCIA-SIEA branching patterns were classified into seven distinctive patterns. This novel classification may help surgeons to choose the optimal pedicle when using the hemi-abdomen region as the donor site.

Superficial Inferior Epigastric Artery (SIEA) Flap is the Armamentarium for the Coverage of Large Complex Wounds on Dorsum of Hand in a Regional Medical College Hospital

As hand is a functional part of the body, dorsal surface of digits, hand and wrist is prone to injury causing complex wound. Thin, mobile and supple skin of the dorsal wrist and hand make significant for hand functions and aesthetic. Aims of the study were feasibility of the flap in terms of survivability of Superficial Inferior Epigastric artery (SIEA) flap, complications of flap and measurement of functional &amp; aesthetic outcomes to achieve the reconstruction goal in hugely burden regional medical college hospital. 11 SIEA flaps were done in Rajshahi Medical College Hospital from August 2019 to July 2021 on both hands among both male and female patients. Only 2 (18.18%) flaps were lost partially. Almost all the wounds were covered successfully with good functional and aesthetic outcome. So, SIEA flap is the one of the best workhorses for extensive dorsal complex wound in overburdened regional medical hospital in Bangladesh.

Pedicled Split Hypogastric Flap (Superficial Inferior Epigastric Artery flap): A New Technique for Coverage of Nonadjacent Defects in the Hand.

Flap coverage of soft tissue defects on both surfaces of the hand or of nonadjacent defects in the hand is a challenge. Two flaps are needed or if a single flap is used, the intervening normal area or part of the flap must be deepithelialized or the flap tunneled under the normal bridge segment. We are presenting a new technique whereby the hypogastric flap based on the superficial inferior epigastric artery is split into 2 components for the coverage of such defects. The hypogastric flap is separated into a cutaneous component and an adipofascial component at the level of Scarpa fascia. The flaps are separated almost to the base to increase mobility. Now it can be used to cover 2 defects separated by 5 to 7 cm or for defects in the dorsum and the palm. We have used it in 3 patients, in 2 for the coverage of palmar and dorsal aspect of the hand and in one for the coverage of nonadjacent defects on the dorsum of the hand and distal forearm after postburn contracture release. We achieved good results with no flap-related complications.

The Superficial Inferior Epigastric Artery Based Abdominal Flap for Reconstruction of Extensive Defects of the Hand and Forearm: A Modified Design With Primary Closure of the Donor Site.

The reconstruction of the hand and forearm targets the restoration of their function and aesthetic appearance. Inferiorly based abdominal flaps are reliable and versatile flaps that can cover large defects of the forearm and hand. Here we present a modified abdominal flap design based exclusively on the superficial inferior epigastric artery (SIEA) to reconstruct the hand and forearm's extensive defects. The donor site is closed primarily. This is a retrospective study of the patients who underwent reconstruction of hand and forearm defects with SIEA flap from 2006 to 2018. The flap was designed on the ipsilateral hemiabdomen with a narrow pedicle based on the SIEA. We describe the anatomical basis and the outcomes of SIEA flap for reconstruction of the hand and forearm's extensive defects. Forty-eight soft tissue defects of the hand and forearm were reconstructed with the SIEA-based abdominal flap. Twenty-nine (60.41%) dorsal defects, 4 (8.33%) volar defects, 4 (8.33%) circumferential defects, 6 (12.5%) hand amputation stump, and 5 (10.41%) finger and thumb defects were covered using the SIEA flap. Forty-seven (97.91%) flaps had complete survival, whereas 1 (2.08%) flap had distal necrosis at the time of division. One (2.08%) flap had marginal necrosis, and 1 (2.08%) flap had distal necrosis after the division. The donor site was closed primarily in all patients. One (2.08%) patient had wound dehiscence at the abdominal donor site. All flaps gave excellent coverage with a satisfactory contour. Abdominal flap based on SIEA is a safe, reliable, and versatile flap for the reconstruction of extensive soft-tissue defects of the hand and forearm. An ability to provide a large amount of skin and soft tissue and the abdominal donor site's primary closure make it a favorable option for upper limb reconstruction in regions with limited resources and technical expertise.

Abstract P4-14-11: Prolonged survival of mice bearing HER2 positive breast cancer with a therapeutic cancer vaccine via intra-reconstructed abdominal flap administration

Abstract Background: Previously we reported a porous silicon micro-particle based cancer vaccine, which stimulated robust CD8+ T cell-dependent anti-tumor immunity in mice bearing HER2-positive breast cancer. In this study we evaluated the efficacy of the vaccine via single injection into reconstructed abdominal flap after primary tumor mastectomy. Method: To generate murine model of HER2 positive breast cancer murine, 1 × 105 TUBO/luciferase cells were injectedinto both mammary gland fat pad and left ventricle of each 6-8 weeks old female Balb/c mice. Primary and systemic metastatic tumor growth were monitored with a IVIS-200 imaging system. Four days after tumor inoculation, mammary gland fat pad with primary tumor was resected by mastectomy, and superficial inferior epigastric(SIE) vessels based abdominal flap was used for abdominal reconstruction. During the surgery, mice also received one of the three treatments below: 1) negative control without treatments; 2) single intra-flap vaccination of cancer vaccine; and 3) single injection of cancer vaccine via footpad injection. Therapeutic efficacy were monitored with IVIS system weekly. To analyze immune response, popliteal and inguinal lymph nodes were collected one day and seven days post vaccination, and activation of dendritic cells and T cells was evaluated with a flow cytometry. HER2 specific T cells in splenocytes which highly expressed interferon-gamma (IFNγ) were counted by ELISpot. CD3+ T cell infiltration in brain metastatic nodules were analyzed by immunohistochemical assay. Result: Prolonged survival of mice bearing HER2-positive breast cancer was achieved by both intra-flap and intra-dermal vaccination of cancer vaccine. Mice vaccinated via intra-flap injection extended median survival by 9 days (p=0.025), although not as long as intra-dermal treatment (15 days, p=0.034), comparing to control group. In lymph nodes, activated dendritic cells increased in both two vaccinated groups. Interestingly, intra-flap vaccination induced higher response in inguinal lymph node, which considered as the major draining lymph node of this route. Meanwhile, intra-dermal vaccination raised higher immune response in popliteal lymph node. In ELISpot assay, IFNγ secreted T cells were found abundant in splenocytes from both two vaccination groups. Furthermore, efficient infiltration of T cells inside the brain metastatic nodules was found in intra-dermal injection group, which provided potential protection from distal recurrence after mastectomy. Conclusion: Cancer vaccine administrated via intra-flap injection effectively stimulated systemic immune response, and slowed down tumor progression in murine HER2 positive breast cancer model. Citation Format: Xiaoling Liu, Junhua Mai, Chaoyang Meng, Wei Wei, Haifa Shen. Prolonged survival of mice bearing HER2 positive breast cancer with a therapeutic cancer vaccine via intra-reconstructed abdominal flap administration [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-14-11.

Perforator Mapping of the Superficial and Deep Inferior Epigastric Artery in the Abdominal Region of the Vietnamese.

BACKGROUND:Previous studies worldwide have investigated the anatomy of the perforators of the deep inferior epigastric arteries to figure out the navigation patterns of the perforators on the abdominal wall. This has been inconsistent amongst the researchers about how to select the perforator to increase the blood supply area for the flap.AIM:To explore the blood supply area of the perforators of the superficial and deep inferior epigastric artery in the abdominal region of the Vietnamese by dissection and 64-slice multislice computed tomography (64-slice MSCT).METHODS:A descriptive cross-sectional study Center from September 2014 to September 2016 on two groups including 30 cadavers fixed by formalin 10% in Anatomy Department of UPNT, and 37 patients getting the 64-slice MSCT abdominal arteries angiogram.RESULTS:The superficial epigastric arteries at the level of the inguinal ligament were located in the middle region, with 96% (right) and 88.5% (left). The anterior superior iliac spine level was in the middle, and lateral regions of 68% and 32% respectively. The level of the umbilical cord was in the lateral region with 66.7% and 85.7%, respectively. There were about 6 perforators of the deep inferior epigastric arteries located in the navel area. These perforators were 70% in the medial region and 30% in the middle region.CONCLUSION:Mapping the blood supply based on the fourth space in the abdominal region in which the superfical inferior epigastric arteries supplied the lateral area. The middle and the internal ones were the perforators of the deep inferior epigastric arteries.

A unidirectional porous beta-tricalcium phosphate promotes angiogenesis in a vascularized pedicle rat model

BackgroundVarious types of artificial bone have been developed as alternatives to autologous bone grafts. In designing artificial bone, a porous structure is essential for the infiltration of blood and cells, which promotes angiogenesis within the bone matrix and ultimately ossification. However, it remains unclear what kind of pore system best promotes ossification. Here, we investigated angiogenesis in three different types of porous β-tricalcium phosphate (β-TCP) in a vascularized pedicle rat model. MethodsThree types of porous β-TCP—β-TCP60 (60% porosity), β-TCP75 (75% porosity), and unidirectional porous β-tricalcium phosphate (UDPTCP; 57% porosity)—were examined. A cylindrical piece of artificial bone was implanted beneath the superficial inferior epigastric (SIE) vessels in the groin of rats and angiogenesis was allowed to occur. Two weeks after surgery, India ink or lectin was systemically injected to detect newly formed blood vessels originating from the SIE vessels. Immunohistochemistry for von Willebrand factor, α-smooth muscle actin, or type IV collagen was performed to clarify the structural features of the newly formed capillaries within the vascularized UDPTCP. ResultsThe vascularity of the UDPTCP was superior to that of β-TCP60 and β-TCP75. The UDPTCP pore structure was completely filled with capillaries at 3 weeks after implantation. Immunohistochemistry showed that the walls of the capillaries contained endothelial cells, pericytes, and basement membrane originating from the SIE vessels, and that the cells proliferated and the basement membrane formed simultaneously as the newly formed capillaries extended through the unidirectional pore structure of the UDPTCP. ConclusionsUDPTCP had greater angiogenic potential than β-TCP60 and β-TCP75 in a vascularized pedicle rat model. Vascularized UDPTCP grafts may be an alternative to vascularized autologous bone grafts.

Algorithmic Approach to the Superficial Inferior Epigastric Artery System Reduces Fat Necrosis in Autologous Breast Reconstruction

Algorithmic Approach to the Superficial Inferior Epigastric Artery System Reduces Fat Necrosis in Autologous Breast Reconstruction

Prélever un SIEP à la place d’un DIEP en reconstruction mammaire : note technique

Breast reconstruction by abdominal flap has evolved to ensure minimal donor-site morbidity with the description of Deep Inferior Epigastric artery Perforator flap (DIEP flap). Being of the same thickness and the same surface, the Superficial Inferior Epigastric Artery flap (SIEA flap) does not require, for it harvesting, to open the abdominal fascia or to dissect through the muscles minimizing again donor-site sequelae. However, it is little used because of the variability of its vascularization and a higher failure rate than the DIEP in the literature. We believe that it is reasonable, in some cases, to harvest a SIEA flap instead of DIEP flap in mammary reconstruction. We present a technical note explaining our operative strategy for reliably taking a SIEA when the caliber of the vessels allows.