Department of Surgical Oncology, DR BRA-IRCH and National Cancer Institute (NCI), All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
Department of Onco-Anaesthesia, DR BRA-IRCH and National Cancer Institute (NCI), All India Institute of Medical Sciences, New Delhi, 110029, India.
World J Surg. 2023 Nov;47(11):2753-2760. doi: 10.1007/s00268-023-07126-x. Epub 2023 Aug 13.
The lateral intercostal artery perforator flap (LICAP) has emerged as one of the safest and less morbid flaps for lateral and central breast defects. We hereby describe a reproducible no Doppler single position (NDSP) technique to harvest it in single position without handheld Doppler, making it a versatile flap for lateral breast defects in resource-limited setting also.
With this technique, we performed a total of 22 LICAP turnover flaps over a period of 18 months from January 2020 to June 2021. In all 22 cases, the indication of flap was to fill the post-breast conservation surgery (BCS) defects in outer quadrant of breast. All LICAP flaps were harvested by surface marking of anatomical landmarks and without handheld Doppler.
Out of 22 LICAP turnover flaps, thirteen were harvested for left breast and nine for right breast. The median width and length of the flap were 12.2 cm and 19.6 cm, respectively. The additional mean operative time was 41 min. All LICAP flaps survived well, and grade 1 Clavien-Dindo morbidity was documented in four cases. Mean hospital stay was 2.6 days. All patients received radiotherapy on their stipulated schedule. Early cosmetic outcome was good, and long-term outcomes are awaited.
NDSP-LICAP flap is a workhorse for lateral breast defects. Precise knowledge of perforators and anatomical landmarks can be used for harvesting these flaps, thus avoiding ultrasound Doppler and dedicated training for perforator localization. This technique has short learning curve without the need for any plastic surgery training. The early cosmetic outcomes are good.
肋间外侧动脉穿支皮瓣（LICAP）已成为治疗侧胸和中央胸缺损最安全、并发症最少的皮瓣之一。我们在此描述了一种可重现的无多普勒单点（NDSP）技术，可在无需手持多普勒的情况下在单点位置采集该皮瓣，使其成为资源有限环境下治疗侧胸缺损的多功能皮瓣。
使用该技术，我们在 2020 年 1 月至 2021 年 6 月期间共进行了 22 例 LICAP 翻转皮瓣手术。在所有 22 例病例中，皮瓣的适应证均为填充保乳手术后（BCS）乳房外象限的缺损。所有 LICAP 皮瓣均通过解剖标志的表面标记和无手持多普勒进行采集。
22 例 LICAP 翻转皮瓣中，13 例用于左侧乳房，9 例用于右侧乳房。皮瓣的平均宽度和长度分别为 12.2cm 和 19.6cm。额外的平均手术时间为 41 分钟。所有 LICAP 皮瓣均存活良好，有 4 例出现 1 级 Clavien-Dindo 并发症。平均住院时间为 2.6 天。所有患者均按规定接受放疗。早期美容效果良好，有待长期随访。
NDSP-LICAP 皮瓣是侧胸缺损的主力皮瓣。准确了解穿支和解剖标志可用于采集这些皮瓣，从而避免使用超声多普勒和专门的穿支定位培训。该技术学习曲线短，无需任何整形手术培训。早期美容效果良好。
