Application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHOU Xiao ¹ , ZHANG Yixin ² , PENG Xiaowei ¹ , ZHOU Bo ¹ , LÜ Chunliu ¹ , PENG Wen ¹ , MAO Huangxing ¹

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China;
2. Department of Plastic and Reconstructive Surgery, the Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200000, P.R.China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Breast cancer; gracilis flap; adductor magnus perforator flap; breast reconstruction

DOI：

10.7507/1002-1892.201801001

Video：

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ObjectiveTo explore the clinical application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction of breast cancer patients after mastectomy.MethodsBetween August 2016 and February 2017, the combined transverse upper gracilis flap and adductor magnus perforator flap was used in 12 cases of breast cancer patients who received modified radical surgery for breast reconstruction. All patients were females with the age of 32 to 59 years (mean, 41.5 years). There were 7 cases in left side and 5 cases in right side. Eight cases were received breast reconstruction by one-stage operation and 4 cases by two-stage operation. In one-stage operation cases, pathological diagnosis includes invasive ductal carcinoma in 4 cases and invasive lobular carcinoma in 4 cases. The disease duration ranged from 2 to 9 months (mean, 4.5 months). In two-stage operation cases, the time interval between mastectomy and breast reconstruction ranged from 12 to 70 months (mean, 37.4 months). The length of flap was 20-28 cm, the width of flap was 5.5-7.5 cm, the thickness of flap was 2.5-4.5 cm. The length of gracilis flap pedicle was 6.5-9.2 cm, the length of adductor magnus perforator flap pedicle was 7.5-10.4 cm. The weight of flap was 295-615 g.ResultsThe ischemia time of flap ranged from 95 to 230 minutes (mean, 135 minutes). All flaps were successfully survived. All incisions of recipient donor sites healed by first intention. All patients were followed up 7-14 months (mean, 9.5 months). The reconstructed breasts’ shape, texture, and elasticity were good and no flap contracture deformation happened. Only linear scar left in the donor sites, but the function of thighs was not affected. No local recurrence happened during follow-up.ConclusionWith appropriate patient selection and surgical technique, the combined transverse upper gracilis flap and adductor magnus perforator flap can be a valuable option as an alternative method for autologous breast reconstruction.

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, ZHANG Yixin, PENG Xiaowei, ZHOU Bo, LÜ Chunliu, PENG Wen, MAO Huangxing. Application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(6): 707-713. doi: 10.7507/1002-1892.201801001 Copy

1.	周晓, 周波, 李赞, 等. 中国肿瘤整形外科的历史与现状——肿瘤外科医师有根治肿瘤的责任, 更有让患者拥有健康美丽生活的义务. 中国耳鼻咽喉颅底外科杂志, 2016, 22(2): 85-90.
2.	Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
3.	Healy C, Allen RJ Sr. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg, 2014, 30(2): 121-125.
4.	Manahan MA, Prucz RB, Shridharani SM, et al. Long-term follow-up of changing practice patterns in breast reconstruction due to increased use of tissue expanders and perforator flaps. Microsurgery, 2014, 34(8): 595-601.
5.	Buntic RF, Horton KM, Brooks D, et al. Transverse upper gracilis flap as an alternative to abdominal tissue breast reconstruction: technique and modifications. Plast Reconstr Surg, 2011, 128(6): 607e-613e.
6.	Seidenstuecker K, Munder B, Mahajan AL, et al. Morbidity of microsurgical breast reconstruction in patients with comorbid conditions. Plast Reconstr Surg, 2011, 127(3): 1086-1092.
7.	Yousif NJ. The transverse gracilis musculocutaneous flap. Ann Plast Surg, 1993, 31(4): 382.
8.	Schoeller T, Huemer GM, Wechselberger G. The transverse musculocutaneous gracilis flap for breast reconstruction: guidelines for flap and patient selection. Plast Reconstr Surg, 2008, 122(1): 29-38.
9.	Bodin F, Dissaux C, Dupret-Bories A, et al. The transverse musculo-cutaneous gracilis flap for breast reconstruction: How to avoid complications. Microsurgery, 2016, 36(1): 42-48.
10.	张世民, 徐达传, 俞光荣, 等. 复 (组) 合皮瓣的分类、供区及临床应用. 中国临床解剖学杂志, 2005, 23 (6): 670-673.
11.	Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg, 2006, 117(7): 151e-160e.
12.	Allen RJ, Haddock NT, Ahn CY, et al. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg, 2012, 129(1): 16e-23e.
13.	Veronesi U, Boyle P, Goldhirsch A, et al. Breast cancer. Lancet, 2005, 365(9472): 1727-1741.
14.	Granzow JW, Levine JL, Chiu ES, et al. Breast reconstruction with perforator flaps. Plast Reconstr Surg, 2007, 120(1): 1-12.
15.	Massey MF, Spiegel AJ, Levine JL, et al. Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions. Plast Reconstr Surg, 2009, 124(3): 737-751.
16.	Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg, 1994, 32(1): 32-38.
17.	Fattah A, Figus A, Mathur B, et al. The transverse myocutaneous gracilis flap: technical refinements. J Plast Reconstr Aesthet Surg, 2010, 63(2): 305-313.
18.	Werdin F, Peek A, Martin NC, et al. Superior gluteal artery perforator flap in bilateral breast reconstruction. Ann Plast Surg, 2010, 64(1): 17-21.
19.	Park JE, Chang DW. Advances and innovations in microsurgery. Plast Reconstr Surg, 2016, 138(5): 915e-924e.
20.	Kim CM, Yun IS, Lee DW, et al. Treatment of ischial pressure sores with both profunda femoris artery perforator flaps and muscle flaps. Arch Plast Surg, 2014, 41(4): 387-393.
21.	Allen RJ Jr, Lee ZH, Mayo JL, et al. The profunda artery perforator flap experience for breast reconstruction. Plast Reconstr Surg, 2016, 138(5): 968-975.
22.	Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg, 2004, 114(1): 69-73.
23.	Saint-Cyr M, Wong C, Oni G, et al. Modifications to extend the transverse upper gracilis flap in breast reconstruction: clinical series and results. Plast Reconstr Surg, 2012, 129(1): 24e-36e.
24.	Craggs B, Vanmierlo B, Zeltzer A, et al. Donor-site morbidity following harvest of the transverse myocutaneous gracilis flap for breast reconstruction. Plast Reconstr Surg, 2014, 134(5): 682e-691e.
25.	Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg, 2011, 127(4): 1720-1729.
26.	Koshima I. A new classification of free combined or connected tissue transfers: introduction to the concept of bridge, siamese, chimeric, mosaic, and chain-circle flaps. Acta Med Okayama, 2001, 55(6): 329-332.

1. 周晓, 周波, 李赞, 等. 中国肿瘤整形外科的历史与现状——肿瘤外科医师有根治肿瘤的责任, 更有让患者拥有健康美丽生活的义务. 中国耳鼻咽喉颅底外科杂志, 2016, 22(2): 85-90.
2. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
3. Healy C, Allen RJ Sr. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg, 2014, 30(2): 121-125.
4. Manahan MA, Prucz RB, Shridharani SM, et al. Long-term follow-up of changing practice patterns in breast reconstruction due to increased use of tissue expanders and perforator flaps. Microsurgery, 2014, 34(8): 595-601.
5. Buntic RF, Horton KM, Brooks D, et al. Transverse upper gracilis flap as an alternative to abdominal tissue breast reconstruction: technique and modifications. Plast Reconstr Surg, 2011, 128(6): 607e-613e.
6. Seidenstuecker K, Munder B, Mahajan AL, et al. Morbidity of microsurgical breast reconstruction in patients with comorbid conditions. Plast Reconstr Surg, 2011, 127(3): 1086-1092.
7. Yousif NJ. The transverse gracilis musculocutaneous flap. Ann Plast Surg, 1993, 31(4): 382.
8. Schoeller T, Huemer GM, Wechselberger G. The transverse musculocutaneous gracilis flap for breast reconstruction: guidelines for flap and patient selection. Plast Reconstr Surg, 2008, 122(1): 29-38.
9. Bodin F, Dissaux C, Dupret-Bories A, et al. The transverse musculo-cutaneous gracilis flap for breast reconstruction: How to avoid complications. Microsurgery, 2016, 36(1): 42-48.
10. 张世民, 徐达传, 俞光荣, 等. 复 (组) 合皮瓣的分类、供区及临床应用. 中国临床解剖学杂志, 2005, 23 (6): 670-673.
11. Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg, 2006, 117(7): 151e-160e.
12. Allen RJ, Haddock NT, Ahn CY, et al. Breast reconstruction with the profunda artery perforator flap. Plast Reconstr Surg, 2012, 129(1): 16e-23e.
13. Veronesi U, Boyle P, Goldhirsch A, et al. Breast cancer. Lancet, 2005, 365(9472): 1727-1741.
14. Granzow JW, Levine JL, Chiu ES, et al. Breast reconstruction with perforator flaps. Plast Reconstr Surg, 2007, 120(1): 1-12.
15. Massey MF, Spiegel AJ, Levine JL, et al. Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions. Plast Reconstr Surg, 2009, 124(3): 737-751.
16. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg, 1994, 32(1): 32-38.
17. Fattah A, Figus A, Mathur B, et al. The transverse myocutaneous gracilis flap: technical refinements. J Plast Reconstr Aesthet Surg, 2010, 63(2): 305-313.
18. Werdin F, Peek A, Martin NC, et al. Superior gluteal artery perforator flap in bilateral breast reconstruction. Ann Plast Surg, 2010, 64(1): 17-21.
19. Park JE, Chang DW. Advances and innovations in microsurgery. Plast Reconstr Surg, 2016, 138(5): 915e-924e.
20. Kim CM, Yun IS, Lee DW, et al. Treatment of ischial pressure sores with both profunda femoris artery perforator flaps and muscle flaps. Arch Plast Surg, 2014, 41(4): 387-393.
21. Allen RJ Jr, Lee ZH, Mayo JL, et al. The profunda artery perforator flap experience for breast reconstruction. Plast Reconstr Surg, 2016, 138(5): 968-975.
22. Wechselberger G, Schoeller T. The transverse myocutaneous gracilis free flap: a valuable tissue source in autologous breast reconstruction. Plast Reconstr Surg, 2004, 114(1): 69-73.
23. Saint-Cyr M, Wong C, Oni G, et al. Modifications to extend the transverse upper gracilis flap in breast reconstruction: clinical series and results. Plast Reconstr Surg, 2012, 129(1): 24e-36e.
24. Craggs B, Vanmierlo B, Zeltzer A, et al. Donor-site morbidity following harvest of the transverse myocutaneous gracilis flap for breast reconstruction. Plast Reconstr Surg, 2014, 134(5): 682e-691e.
25. Hallock GG. The complete nomenclature for combined perforator flaps. Plast Reconstr Surg, 2011, 127(4): 1720-1729.
26. Koshima I. A new classification of free combined or connected tissue transfers: introduction to the concept of bridge, siamese, chimeric, mosaic, and chain-circle flaps. Acta Med Okayama, 2001, 55(6): 329-332.

Chinese Journal of Reparative and Reconstructive Surgery

Application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction

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