Biomedical subjects

Joshua L Levine

Publications and source records attributed to Joshua L Levine.

5 recordsLinked to original sources

PubMed2006

Breast reconstruction using perforator flaps.

BACKGROUND: Perforator flaps allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor-site morbidity. The deep inferior epigastric artery (DIEP) and superficial inferior epigastric artery (SIEA) flaps transfer the same tissue from the abdomen to the chest for breast reconstruction as the TRAM flap without sacrificing the rectus muscle or fascia. Gluteal artery perforator (GAP) flaps allow transfer of tissue from the buttock, also with minimal donor-site morbidity. INDICATIONS: Most women requiring tissue transfer to the chest for breast reconstruction or other reasons are candidates for perforator flaps. Absolute contraindications to perforator flap breast reconstruction include history of previous liposuction of the donor site or active smoking (within 1 month prior to surgery). ANATOMY AND TECHNIQUE: The DIEP flap is supplied by intramuscular perforators from the deep inferior epigastric artery and vein. The SIEA flap is based on the SIEA and vein, which arise from the common femoral artery and saphenous bulb. GAP flaps are based on perforators from either the superior or inferior gluteal artery. During flap harvest, these perforators are meticulously dissected free from the surrounding muscle which is spread in the direction of the muscle fibers and preserved intact. The pedicle is anastomosed to recipient vessels in the chest and the donor site is closed without the use of mesh or other materials. CONCLUSIONS: Perforator flaps allow the safe and reliable transfer of abdominal tissue for breast reconstruction.

Breast Neoplasms↗

PubMed2006

Breast reconstruction with gluteal artery perforator flaps.

BACKGROUND: Several alternatives exist for breast cancer reconstruction with perforator flaps. For those patients in whom the buttock is the best choice as a source for autologous tissue, the IGAP and SGAP flaps are an excellent option. These flaps allow the reliable transfer of skin and soft tissue from the buttock without the associated donor site morbidity of a muscle flap. INDICATIONS: Most women requiring tissue transfer to the chest from the buttock for breast reconstruction or other reasons are candidates for IGAP or SGAP flaps. Do to an improved donor site contour and scar, we now prefer to use the IGAP to the SGAP flap. Absolute contraindications specific to perforator flap breast reconstruction in our practice include history of previous liposuction of the donor site or active smoking (within 1 month prior to surgery). ANATOMY AND TECHNIQUE: IGAP and SGAP flaps are based on perforators from either the superior or inferior gluteal artery. These perforators are carefully dissected free from the surrounding gluteus maximus muscle, which is spread in the direction of the muscle fibres and safely preserved. The vascular pedicle is anastomosed to recipient vessels in the chest and the donor site closed primarily. CONCLUSIONS: IGAP and SGAP flaps allow the safe and reliable transfer of tissue from the buttock for breast reconstruction as an alternative to soft tissue transfer from an abdominal donor site or even as a first choice in selected patients.

Arteries↗

PubMed2006

Breast reconstruction with the deep inferior epigastric perforator flap: history and an update on current technique.

Perforator flaps allow the transfer of the patient's own skin and fat in a reliable manner with minimal donor site morbidity. For breast reconstruction, the abdomen typically is our primary choice as a donor site. The deep inferior epigastric perforator (DIEP) flap remains our first choice as an abdominal perforator flap and has become a mainstay for the repair of mastectomy defects. It allows the transfer of the same tissue from the abdomen to the chest for breast reconstruction as the TRAM flap without sacrifice of the rectus muscle or fascia. We discuss our current techniques and specific issues related to the surgery. We present the results of 1095 cases of free tissue transfers from the abdomen for reconstruction of the breast.

Abdominal Wall↗

PubMed2006

The in-the-crease inferior gluteal artery perforator flap for breast reconstruction.

BACKGROUND: Perforator free flaps harvested from the abdomen or buttock are excellent options for breast reconstruction. They enable the reconstructive surgeon to recreate a breast with skin and fat while leaving muscle at the donor site undisturbed. The gluteal artery perforator free flap using buttock tissue was first introduced by the authors' group in 1993. Of the 279 gluteal artery perforator flaps, the authors have performed for breast reconstruction, 220 have been based on the superior gluteal artery and 59 have been based on the inferior gluteal artery. The authors have found that for some women with excess tissue in the upper buttock and hip area, use of the gluteal artery perforator flap resulted in an improvement at the donor site, whereas for others the aesthetic unit of the buttock was clearly disrupted. Therefore, the authors have recently been placing the scar in the inferior buttock crease to improve donor-site aesthetics. METHODS: The authors have now performed 31 in-the-crease inferior gluteal artery perforator free flaps for breast reconstruction and found that the results are very favorable. RESULTS: The removal of tissue from the inferior buttock results in a tightened, lifted appearance. The resultant scar is well concealed within the infrabuttock crease, and exposure or injury of the sciatic nerve has not occurred. Extended beveling at this site is also possible, with less risk of causing an unsightly depression. The final aesthetic result of the scar lying within the inferior buttock crease is very favorable. All patients report satisfaction with the donor site. Complications included one total flap loss, two reoperations for venous congestion, one hematoma, two cases with delayed wound healing at the recipient site, and one with delayed wound healing at the buttock. CONCLUSION: The in-the-crease inferior gluteal artery perforator flap from the buttock is now the authors' primary alternative to the deep inferior epigastric perforator flap from the abdomen for breast reconstruction.

Adult↗

PubMed2005

Algorithm for autologous breast reconstruction for partial mastectomy defects.

BACKGROUND: The use of lateral thoracic skin and fat for breast reconstruction is advantageous because it does not require the use of muscle transfer, and the donor-site incision is well hidden under the arm. In patients with redundant skin at the thoracic flank, use of this tissue has the added benefit of removal of an unsightly roll. The lateral thoracic skin and fat flap can be harvested using microsurgical technique based on three different pedicles: the thoracodorsal artery perforators; a direct cutaneous branch of the thoracodorsal, axillary, or lateral thoracic arteries; and the lateral thoracic intercostal perforating vessel. METHODS: The authors describe the techniques for harvest of lateral thoracic tissue based on each of the pedicle options. A case is then presented to illustrate each option, and an algorithm is suggested for deciding which pedicle to use. RESULTS: The authors have used lateral thoracic tissue for partial breast reconstruction for a variety of defects. In this report, the authors review the results of three illustrative cases. CONCLUSIONS: Partial breast reconstruction may be required for patients after breast-conserving therapy or after breast reconstruction by other methods. Lateral thoracic tissue can be safely transferred to correct defects in treated or reconstructed breast, or to obtain symmetry. Knowledge of the vascular anatomy to this region is helpful in understanding the pedicle options when harvesting this tissue. The authors present an algorithm for determining which pedicle is most appropriate for the transfer of lateral thoracic tissue for partial breast reconstruction.

Adult↗