Intramuscular Perforator Dissection with the Hydrodissection Technique

Dhruv Singhal; Adeyiza O. Momoh; Salih Colakoglu; Ali Qureshi; Adam M. Tobias; Bernard T. Lee

doi:10.1055/s-0032-1326738

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2013; 29(01): 045-050
DOI: 10.1055/s-0032-1326738

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intramuscular Perforator Dissection with the Hydrodissection Technique

Authors

Dhruv Singhal

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Adeyiza O. Momoh

²Division of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
Salih Colakoglu

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Ali Qureshi

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Adam M. Tobias

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Bernard T. Lee

¹Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

Abstract

Background Perforator flap breast reconstruction requires increased time for safe perforator dissection, especially the intramuscular course. We describe an adjunctive technique using hydrodissection to assist with the intramuscular perforator dissection.

Methods Hydrodissection techniques were used for perforator dissection in 45 consecutive patients (64 flaps) undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. These patients were compared with 39 patients (55 flaps) immediately prior to the use of this technique. The study time frame was between March 2008 and March 2010. Patient demographics, complications, and operative times were collected through an extensive chart review.

Results There were no major differences in complications between groups; there were no flap losses encountered during this series, and fat necrosis rates were similar (9.4% with hydrodissection and 14.5% without, p = 0.41). Total operative time for bilateral reconstructions decreased by 59 minutes (p = 0.13) and 21 minutes (p = 0.57) for unilateral reconstructions with the utilization of hydrodissection, though this was not statistically significant.

Conclusions The use of hydrodissection to assist with intramuscular perforator vessel dissection is safe to perform, as there was no increase in complications. The procedures utilizing hydrodissection were faster, and surgeons using this technique found it easier to visualize the perforators and dissect through the intramuscular course.

Keywords

perforator flaps - breast reconstruction - hydrodissection

Full Text

References

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