Abstract
Free TRAM flaps (transverse rectus abdominis myocutaneous flaps), including DIEP flaps (deep inferior epigastric perforator flaps), are among the most useful flaps in breast reconstruction. Vascular territory varies among individuals. We sometimes encounter partial fat necrosis of the TRAM flap after a breast reconstruction. Partial fat necrosis is a minor complication, but it can influence the contour of the reconstructed breast in some cases. When partial fat necrosis occurs, it develops in the hypo-vascularity region of the TRAM flap’s fat layer. It is very difficult for us to determine the presence and exact location of regions of hypo-vascularity in TRAM flaps intraoperatively.
Intraoperative ICG fluorescence angiography is the best method of identifying the viable vascular territory of TRAM flaps.
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References
Eren S, Rübben A, Krein R, Larkin G, Hettich R (1995) Assessment of microcirculation of an axial skin flap using indocyanine green fluorescence angiography. Plast Reconstr Surg 96:1636–1649
Still J, Law E, Dawson J, Bracci S, Island T, Holtz J (1999) Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg 42:266–274
Holm C, Mayr M, Höfter E, Becker A, Pfeiffer UJ, Mühlbauer W (2002) Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green. Br J Plast Surg 55:635–644
Holm C, Tegeler J, Mayr M, Becker A, Pfeiffer UJ, Mühlbauer W (2002) Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary experience. Microsurgery 22:278–287
Pestana IA, Coan B, Erdmann D, Marcus J, Levin LS, Zenn MR (2009) Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg 123:1239–1244
Yamaguchi S, De lorenzi F, Petit JY, Rietjen M, Garusi C, Giraldo A, Rey PC, Urban C, Martella S, Bosco R (2004) The “Perfusion Map” of the unipedicle TRAM flap to reduce postoperative partial necrosis. Ann Plast Surg 53:205–209
Holm C, Mayr M, Höfter E, Ninkovic M (2007) The versatility of the SIEA flap: a clinical assessment of the vascular territory of the superficial epigastric inferior artery. J Plast Reconstr Aesthet Surg 60:946–951
Newman MI, Samson MC (2009) The application of laser-assisted indocyanine green fluorescent dye angiography in microsurgical breast reconstruction. J Reconstr Microsurg 25:21–26
Moyer HR, Losken A (2012) Predicting mastectomy skin flap necrosis with indocyanine green angiography: the gray area defined. Plast Reconstr Surg 129:1043–1048
Wu C, Kim S, Halvorson EG (2013) Laser-assisted indocyanine green angiography a critical appraisal. Ann Plast Surg 70:613–619
Pestana IA, Coan B, Erdman D, Marcus J, Levin LS, Zenn MR (2009) Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg 123:1239–1244
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Takeishi, M. (2016). ICG Fluorescence Navigation Surgery in Breast Reconstruction with TRAM Flaps. In: Kusano, M., Kokudo, N., Toi, M., Kaibori, M. (eds) ICG Fluorescence Imaging and Navigation Surgery. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55528-5_20
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DOI: https://doi.org/10.1007/978-4-431-55528-5_20
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