vi breast reconstructive course on cadaver alicante, spain october 4-5, 2013 course director: josé...
TRANSCRIPT
![Page 1: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/1.jpg)
VI Breast Reconstructive Course on CadaverAlicante, SpainOctober 4-5, 2013
Course Director:José F. Salvador Sanz, M.D., Spain
International Faculty:Jaume Masià, M.D., SpainThomas Schöeller, M.D., DeutschlandDr. Michel Saint-Cyr, M.D., USA
VI Breast Reconstructive Course on CadaverAlicante, SpainOctober 4-5, 2013
Course Director:José F. Salvador Sanz, M.D., Spain
International Faculty:Jaume Masià, M.D., SpainThomas Schöeller, M.D., DeutschlandDr. Michel Saint-Cyr, M.D., USA
Local Faculty:V. Almenar García, M.D., SpainF. Terol Calpena, M.D., SpainJ. A. Robles Laguna, M.D., SpainE. Lorda Barraquer, M.D., SpainA. Novo Torres, M.D., SpainJ. J. Aparicio, M.D., Spain
Dissection Room Technicians:A. Sanchez de la Blanca Mesa, SpainP. Ortuño Hernández, Spain
Local Faculty:V. Almenar García, M.D., SpainF. Terol Calpena, M.D., SpainJ. A. Robles Laguna, M.D., SpainE. Lorda Barraquer, M.D., SpainA. Novo Torres, M.D., SpainJ. J. Aparicio, M.D., Spain
Dissection Room Technicians:A. Sanchez de la Blanca Mesa, SpainP. Ortuño Hernández, Spain
The VIthAnnual BREAST RECONSTRUCTIVE COURSE ON CADAVER
DISSECTION COURSE GUIDE
![Page 2: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/2.jpg)
TABLE OF CONTENTS
Flap Name Page
Deep Inferior Epigastric Perforator (DIEP) Flap 3 Superficial Inferior Epigastric Artery (SIEA) Flap 7 Superior Gluteal Artery Perforator (S-GAP) Flap 11 Thoracodorsal Artery Perforator (TDAP) Flap 18 Lateral Intercostal Artery Perforator (LICAP) Flap 23 Transverse Myocutaneous Gracilis (TMG/TUG) Flap Lymph-node adiposal flap transfer
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 3: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/3.jpg)
DEEP INFERIOR EPIGASTRIC PERFORATOR (DIEP) FLAP
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 4: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/4.jpg)
Flap: Deep Inferior Epigastric Perforator (DIEP)
Tissues available: cutaneous __________________________________________________________________Vascular Anatomy: deep inferior epigastric artery perforators __________________________________________________________________Innervation: intercostal nerves __________________________________________________________________Flap Dimensions: 15 x 30 cm __________________________________________________________________Advantages: no muscle sacrifice, acceptable donor site scar, ample available tissue __________________________________________________________________Disadvantages: technically demanding, anatomic variations, less perfusion than variant which includes rectus muscle and multiple perforators (TRAM, msTRAM) __________________________________________________________________Things to note: single perforator larger than 1.5mm adequate; spare intercostal motor nerves __________________________________________________________________Notes:
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 5: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/5.jpg)
NEUROVASCULAR ANATOMY
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 6: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/6.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 7: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/7.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 8: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/8.jpg)
SUPERFICIAL INFERIOR EPIGASTRIC ARTERY (SIEA) FLAP
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 9: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/9.jpg)
Flap: Superficial Inferior Epigastric Artery (SIEA)
Tissues available: cutaneous ___________________________________________________________________Vascular Anatomy: superficial inferior epigastric artery ___________________________________________________________________Innervation: noneFlap Dimensions: 15 x 20 cm ___________________________________________________________________Advantages: no muscle sacrifice or fascial incision required, acceptable donor site scar, ample available tissue ___________________________________________________________________Disadvantages: technically demanding, anatomic variations, seldom present greater than 1.5mm in diameter, limiting its use ___________________________________________________________________Things to note: poor perfusion across midline; may have added blood supply via SCIA (see groin flap) or adding a DIEP pedicle ___________________________________________________________________Notes:
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 10: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/10.jpg)
ARTERIAL SUPPLY TO SIEA FLAP
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 11: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/11.jpg)
SUPERIOR GLUTEAL ARTERY PERFORATOR (S-GAP) FLAP
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 12: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/12.jpg)
Flap: S-GAP Flap
Tissues available: skin, fat, (muscle) ___________________________________________________________________Vascular Anatomy: superior gluteal artery(2-3mm) and vein(3-4mm); pedicle 6 cm ___________________________________________________________________Innervation: no sensory nerve with flap ___________________________________________________________________Flap Dimensions: 13x30cm ___________________________________________________________________Advantages: available donor site in most patients; hidden donor scar; mimicks buttock lift ___________________________________________________________________Disadvantages: must harvest in lateral or prone position, sometimes necessitating position change during case; contour deformities may require revision and contralateral contour procedures; donor site seromas common; ___________________________________________________________________Things to note: if fat distribution is inferior, then I-GAP preferred. Upper hip tissues can be carried on the SGA or lumbar vessels and CTA or MRA may aide flap design. ___________________________________________________________________Notes:
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 13: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/13.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 14: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/14.jpg)
GT GREATER TROCHANTERPSIS POSTEROSUPERIOR ILIAC SPINEC COCCYXP MEDIAL POINTF 2/3 POINT
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 15: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/15.jpg)
THORACODORSAL ARTERY PERFORATOR (TDAP) FLAP
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 16: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/16.jpg)
Flap: TDAP Flap
Tissues available: skin, (muscle) ___________________________________________________________________Vascular Anatomy: thoracodorsal artery(2-4mm), vein (2-5mm); pedicle length 8 cm, which can be lengthened by including subscapular trunk; ___________________________________________________________________Innervation: thoracodorsal nerve (motor), lateral cutaneous branches of the intercostal nerves(sensory) ___________________________________________________________________Flap Dimensions: 9x22 cm (primary closure) ___________________________________________________________________Advantages: large size, long pedicle (15 cm); ___________________________________________________________________Disadvantages: need lateral positioning; large scar; ___________________________________________________________________Things to note: better for lateral defects and partial breast reconstruction ___________________________________________________________________Notes:
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 17: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/17.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 18: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/18.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 19: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/19.jpg)
LATERAL INTERCOSTAL ARTERY PERFORATOR (LICAP) FLAP
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 20: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/20.jpg)
Flap: LICAP Flap
Tissues available: skin, (muscle) ___________________________________________________________________Vascular Anatomy: lateral intercostal artery(1-1.5mm), vein (1-2mm); pedicle length 15 cm ___________________________________________________________________Innervation: cutaneous branches of the intercostal nerves(sensory) ___________________________________________________________________Flap Dimensions: 24 x 14 cm (primary closure) ___________________________________________________________________Advantages: large size, long pedicle (15 cm); ___________________________________________________________________ Disadvantages: need lateral positioning; large scar; ___________________________________________________________________Things to note: better for lateral defects and partial breast reconstruction ___________________________________________________________________Notes:
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 21: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/21.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 22: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/22.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 23: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/23.jpg)
TRANSVERSE MYOCUTANEOUS GRACILIS (TMG/TUG) FLAP
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 24: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/24.jpg)
Flap: TUG/TMG Flap
Tissues available: skin, (muscle) ___________________________________________________________________Vascular Anatomy: medial femoral circumflex artery(1.0-1.8mm) and vein(1.5-3.0mm); pedicle length 6-7cm; ___________________________________________________________________Innervation: anterior obturator nerve (motor); medial cutaneous nerve of the thigh(sensory) ___________________________________________________________________Flap Dimensions: 8x12 cm ___________________________________________________________________Advantages: expendable muscle good for additional bulk; acceptable scar location ___________________________________________________________________Disadvantages: Limited volume, especially anteriorly; small arterial diameter; seromas ___________________________________________________________________Things to note: transverse skin paddle in based in groin crease best aesthetic; avoid femoral triangle lymph nodes and stay subcutaneous to avoid lymphedema issues ___________________________________________________________________Notes:
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 25: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/25.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 26: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/26.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013
![Page 27: VI Breast Reconstructive Course on Cadaver Alicante, Spain October 4-5, 2013 Course Director: José F. Salvador Sanz, M.D., Spain International Faculty:](https://reader036.vdocuments.us/reader036/viewer/2022081515/56649ec05503460f94bcabae/html5/thumbnails/27.jpg)
VI BREAST RECONSTRUCTION COURSE ON CADAVERALICANTE 4-5 OCTOBER, 2013