Enlarged perforating flaps of the anterior thoracic and abdominal wall: A novel approach to autologous breast reconstruction

Abstract

Aim. To develop methods for obtaining enlarged perforating flaps on the anterior surfaces of the thoracic and abdominal walls. Material and methods: The study included 16 patients with post-burn breast deformities aged from 5 to 22 years. In the upper part of the anterior surface of the chest, the flaps were formed on the basis of 2, 3 anterior intercostal artery perforator and thoracoacromial artery perforator with the inclusion of the vascular network of the thoracic branch of the supraclavicular artery. In the lower part of the thoracic and upper abdominal wall, there were also enlarged flaps based on the superior epigastric artery perforator with the connection of vascular networks 6, 7 anterior intercostal artery perforator and perforator deep inferior epigastric artery. The obtained flaps were moved by direct advancement, rotation and transposition methods. Results: The largest area of the wound defect was closed with flaps that were moved by rotation and it was 1.8 times larger than the area of wounds closed by direct advancement and 1.3 times larger than if using transposition flaps. The use of stretched perforating flaps from the anterior surface of the thoracic and abdominal walls allowed to obtain a positive result in 90.4% of cases with the short-term treatment, and in all cases with the long-term treatment. Conclusion: A simple technique based on the proposed methods can be widely used for the reconstruction of the upper and lower quadrants of the breast and intermammary and submammary spaces.