Descriptive anatomy of the inferior epigastric, subscapular and internal thoracic vascular pedicles in three domestic mammals: A comparative study.

The descriptive anatomy of the inferior epigastric, subscapular and internal thoracic vascular pedicles of domestic animals is not fully known. Improvement of our knowledge in this field could lead to better development of animal models for both pedagogical purposes and surgical experimentation. The objective of this comparative study was to describe the descriptive anatomy of the inferior epigastric, subscapular and internal thoracic pedicles in three domestic mammals commonly used as animal models for experimentation. Our study focuses on the anatomical description of these vascular pedicles in the rat (Rattus norvegicus) (n=1), the rabbit (Oryctolagus cuniculus) (n=1) and the pig (Sus scrofa domesticus) (n=1). A comparative and analytical study of these vessels (origin, path, caliber, termination) with those of humans was carried out. The superficial inferior epigastric vascular pedicles have been identified only in rats and pigs. The deep inferior epigastric, subscapular and internal thoracic pedicles were identified in the three mammals studied. No perforator vessels for the subcutaneous tissue and skin were identify from the deep inferior epigastric pedicles. The anatomical characteristics (origin, path, termination) of these vascular pedicles in rabbits seems to be the closest to that of humans. However the caliber of these vessels is around a millimeter compared to a 2.0-3.0mm in humans. This comparative study allowed us to identify and better characterize the morphological characteristics of these vascular pedicles in three domestic mammals, a step prior improving the development of animal models intended for pedagogical or experimental purposes in the field of microsurgical free flaps.

Design, characterization and in vivo performance of synthetic 2 mm-diameter vessel grafts made of PVA-gelatin blends.

Since the development of the first vascular grafts, fabrication of vessel replacements with diameters smaller than 6 mm remains a challenge. The present work aimed to develop PVA (poly (vinyl alcohol))-gelatin hybrids as tubes suitable for replacement of very small vessels and to evaluate their performance using a rat abdominal aorta interposition model. PVA-gelatin hybrid tubes with internal and external diameters of 1.4 mm and 1.8 mm, respectively, composed of 4 different gelatin ratios were prepared using a one-step strategy with both chemical and physical crosslinking. By 3D Time of Flight MRI, Doppler-Ultrasound, Computed Tomography angiography and histology, we demonstrated good patency rates with the 1% gelatin composition until the end of the study at 3 months (50% compared to 0% of PVA control grafts). A reduction of the patency rate during the time of implantation suggested some loss of properties of the hybrid material in vivo, further confirmed by mechanical evaluation until one year. In particular, stiffening and reduction of compliance of the PVA-gelatin grafts was demonstrated, which might explain the observed long-term changes in patency rate. These encouraging results confirm the potential of PVA-gelatin hybrids as ready-to-use vascular grafts for very small vessel replacement.

[Breast reconstruction with profunda artery perforator flap: A prospective study of 30 consecutive cases]. / Reconstruction mammaire par profunda artery perforator flap : étude prospective des 30 premiers cas consécutifs.

INTRODUCTION: Many flaps have been described in autologous breast reconstruction, the most common being the deep inferior epigastric perforator (DIEP) flap. This flap cannot be harvested in a certain range of patients. The profunda artery perforator (PAP) flap, based on perforators from profunda femoral artery, is therefore a good option. OBJECTIVE: The goal was to highlight technical tips, particularities, and complications of our series of the 30 first PAP flaps for breast reconstruction in our department. PATIENTS AND METHOD: We did a prospective study of all PAP flaps for breast reconstruction between November 2014 and October 2015. Thirty patients were included. We used 2 different types of skin design: classical or with vertical extension. The following parameters were recorded: pedicle length, flap weight, surgery duration, complications on donor or recipient site and type of recipient vessels. RESULTS: Seventy-seven percent of the cases were delayed breast reconstruction, 23% were immediate. Twenty-five flaps were with classical skin design, and 5 with vertical extension. Mean flap weight was 301g (195-700g). Mean pedicle length was 9.88cm (8.2-12.5cm). Internal mammary vessels were the recipient vessels for 90% of the patients, versus 10% for circumflex scapular vessels. Mean surgery duration was 328min (195-610min). We had two total flap failures. The complications on the donor-site were 2 seroma, and 4 late healing scars. No lymphoedema occurred. CONCLUSION: PAP flap is a good option when abdominal flap harvesting is not possible. The donor-site is well tolerated, with low morbidity. The indication is for patients with small to medium breast volume.

A new strategy for prophylactic surgery in BRCA women: Combined mastectomy and laparoscopic salpingo-oophorectomy with immediate reconstruction by double DIEP flap.

BACKGROUND: Prophylactic surgery remains the most effective modality for reducing both breast and ovarian cancer rate in woman at high risk, such as BRCA1 or BRCA2. Autologous breast reconstruction with bilateral deep inferior epigastric perforator (DIEP) flap allows predictable and durable results. However, existing two-step approach separating salpingo-oophorectomy and reconstruction could even make DIEP flap impossible, or make insufflation more difficult during laparoscopy. Other authors described one-step procedure but with open laparotomy. The goal of this study was to verify the feasibility of a simultaneous procedure, including laparoscopic salpingo-oophorectomy. METHODS: We included BRCA mutation careers scheduled for simultaneous laparoscopic salpingo-oophorectomy, and bilateral breast reconstruction with DIEP flaps. The first step of the procedure was laparoscopic salpingo-oophorectomy and ports had to be strategically placed to avoid interference with the following procedure. The second step was bilateral breast reconstruction with DIEP flaps. We reviewed medical charts. Surgical procedure was analyzed for duration, revisions and surgical complications. RESULTS: During 1-year period, eight patients agreed to a simultaneous procedure. All of them were BRCA positive, mean age was 38.3years (range, 39-50), and mean BMI was 28.3kg/m(2) (range, 21-33). The mean duration of the entire procedure was 524minutes (range, 405-630) and the mean hospital stay 9.2 days (range, 8-14). There was 100% flap survival. No abdominal wall dehiscence occurred. CONCLUSION: One-step procedure for prophylactic surgery of ovarian and breast hereditary malignancies is feasible. First salpingo-oophorectomy with open laparoscopy then bilateral immediate or delayed breast reconstruction with DIEP flaps can be performed.

[Breast reconstruction with Profunda Artery Perforator flap in lithotomy position. Surgical technique]. / Reconstruction mammaire par Profunda Artery Perforator flap prélevé en position gynécologique. Technique chirurgicale.

Autologous breast reconstruction provides great cosmetic, functional and sustainable incomes. Various flaps have been described in autologous breast reconstruction, Deep Inferior Epigastric Perforator flap (DIEP) being the most frequent. For patients with a non-sufficient abdomen for a DIEP based breast reconstruction, the Profunda Artery Perforator Flap (PAP), based on profunda arteris perforators, is a current trend, but few publications detailed the flap harvest. Comparing with a TUG flap, the morbidity linked to the muscle harvest is decreased. Usually the dissection is done in prone or in "frog leg" position. The aim is to describe a technical option: we propose a different position, with a harvest of the PAP in lithotomy position. It offers additional comfort and security for the surgeon and decreases the operative time. The pedicle had an average of 7cm in length; the artery diameter was 2.2mm and the vein 2.5mm. The cosmetic incomes are very good six months postoperative.

[Morphological evaluation of genioplasty associated with orthognathic surgery]. / Évaluation morphologique des génioplasties associées à la chirurgie orthognathique.

INTRODUCTION: The maxillo-mandibulary dysphormias are frequently associated with morphological abnormalities of the chin. Their correction in the sagittal and transverse planes can benefit both morphologically and functionally. The purpose of this study was to evaluate the morphological benefit of the osseous genioplasty associated with orthognathic surgery depending on the type of technique used, as well as complications occurred. PATIENTS AND METHODS: We identified patients who underwent osseous genioplasty associated with orthognathic surgery in our department between 2004 and 2010. For each patient Angle class, type of osteotomy, genioplasty and postoperative complications were recorded. The morphological results were evaluated by a group of surgeons and a group of observers using standardized photographs. RESULTS: Of the 203 facial osteotomies performed during this period, 101 osseous genioplasties were made. In most cases, there was a height reduction associated with advancement of the chin. The morphological results were considered as satisfactory all evaluators alike (3.92). The best results were obtained in height reductions with advancement techniques as sliding genioplasty (4.03) and jumping divided genioplasty (4.19). Five patients (5.9%) had a postoperative complication. This was especially one mental nerve injury and two dental mortifications. No default of consolidation or necrosis or hematoma of mouth floor have been reported. CONCLUSION: Osseous genioplasty is a safe, reliable procedure with morphological satisfactory outcome, in combination with orthognathic surgery. The best results were obtained with cases of height reduction with advancement of the chin, especially the original technique of the jumping divided genioplasty.