Michael Veber

Analysis of a series of autologous fat tissue transfer for lower limb atrophies.

Localized and circumferential atrophies of the lower extremities have been difficult to treat with few simple autologous solutions available. The aim of this study was to analyze the efficacy of fat grafting in lower limb atrophies. There were 20 patients (17 females and 3 males) at an average age of 33 years. Twelve patients had localized and 8 patients circumferential atrophies of various etiologies: traumatic (60%), congenital (25%), and iatrogenic (15%). The average number of fat injections was 1.1 per patient (range 1–2) for localized atrophies and 2.2 per patient (range 1–3) for circumferential atrophies. The average follow-up period was 2 years. The average volume injected at each stage was 79 mL for localized atrophies and 137 mL for circumferential atrophies. In the cases of circumferential atrophies, an average augmentation of 1.9 cm (range 1–6 cm) of the limb perimeter per injection was achieved. The overall satisfaction of the patients was high. Autologous fat grafting is a reliable technique for lower limb atrophies.

Le lambeau de grand dorsal avec conservation du muscle. Étude anatomique et indications en reconstruction mammaire

BACKGROUND The muscle-sparing latissimus dorsi flap pedicled on descending branch presents distinct advantages in breast reconstruction, specially when there is a transversely oriented skin paddle, including reduced donor site morbidity, sparing muscle function and greater freedom of orientation of the skin paddle. This study reports the anatomical basis, surgical technique, advantages and complications of this technique. Four clinical cases illustrate surgical indications in breast reconstructive surgery. METHODS An anatomical cadaveric study underwent to University of Texas Southwestern Medical Center, Dallas. The goal was performed to determine the location of the bifurcation of the thoracodorsal artery and the course of its descending branch compare to the anterior side of latissimus dorsi muscle. Four clinical cases illustrated indications of muscle-sparing latissimus dorsi flap pedicled on descending branch in breast reconstruction. These cases showed advantages and complications of the technique, and impact on donor site. RESULTS Fifteen descending branch muscle-sparing latissimus dorsi flaps were harvested. All flaps had a bifurcation of the thoracodorsal artery. The average was located at 5,1cm from posterior axillary side (from 2,1 to 7,5 cm) and average of 2,2 cm from the anterior side of latissimus dorsi muscle (from 1,3 to 3,1cm). To 5, 10 and 15 cm from posterior axillary side, the descending branch was located at respectively an average of 2,0 cm (from 1,4 to 2,5), 2,4 cm (from 1,3 to 3,3), and 2,9 cm (from 2,0 to 3,8) behind the anterior side of latissimus dorsi muscle. The average length of descending branch was measured at 15,2 cm (from 13,2 to 19,0). None clinical cases paddle suffering was observed. Donor site morbidity was less than classical or extended adipomuscular technique. Latissimus dorsi muscle function is spared. CONCLUSIONS The muscle-sparing latissimus dorsi flap, pedicled on descending branch, is versatile and reproducible. It results in minimal functional deficit of the donor site, absence of seroma, large freedom of orientation of the skin paddle, low rate of flap complications, and a cosmetically acceptable scar. There are a lot of indications in breast reconstruction.

Autologous Breast Reconstruction Using Muscle Sparing Latissimus Dorsi Flap and Fat Grafting

Autologous breast reconstruction using muscle sparing latissimus dorsi flap (MSLD) combined with fat grafting is a new surgical technique that minimizes consequences to the donor site as much as possible. Its main special feature is the harvest of an anterior 3 cm muscle band from the latissimus dorsi muscle, on the descending branch of the thoracodorsal pedicle, where reliability has been assessed through a prior anatomic and radiological study. Its main advantages are the morbidity reduction at the donor site, full function retention in the latissimus dorsi muscle, a better post-operative physical recovery for the patient and a greater freedom of movement in the skin paddle of the flap. Combining this technique with fat grafting means that breast reconstruction can be performed to a satisfactory size in a pure autologous manner without having to use an implant.

Lateral Intercostal Artery Perforator Flap: Use in the Treatment of Breast Tumorectomy Sequelae

Lateral breast defect after partial mastectomy is a difficult challenge. Pedicled perforator flap is a new indication for breast surgery. Perforator flaps and fat tissue transplant are new concepts in this kind of reconstruction. Lateral intercostal artery perforator (LICAP) flap has been used for a lot of indications. It can be used for lateral breast defect reconstruction. This flap provides several advantages: minimal donor site morbidity, advantages in flap shaping, better aesthetic results and higher patient satisfaction. The aim of this chapter is to present the technique of LICAP flap and discuss its indications and advantages and its limits in lateral breast reconstruction after partial mastectomy. LICAP flap provides a new solution instead of conventional flaps.