Saturday, September 11, 2010

A Perfect Microsurgical Anastomosis (Blood Vessel Repair)

Above: Microsurgical anastomosis between the Internal Mammary Artery and Vein to the Deep Inferior Epigastric Artery Perforator (DIEP) Vessels using an Operating Microscope.  Dr. Alexis Carrell from the University of Chicago (1902) proved that we can successfully reconnect blood vessels using a technique called "triangulation"--he received the Nobel Prize for his efforts.  Microscopes were used in vascular surgery in the 1960s (Jacobsen) and this allowed for blood vessels to be repaired that were less than 2millimeters.  This began the revolution in Reconstructive MicroSurgery, the same techniques that allow us to Reconstruct the Breast by Tissue Transplantation (from the abdomen --TRAM, DIEP--, thighs, etc) and also allows Plastic Surgeons to transplant a hand or face.
Above:  Close up of the Microsurgical Anastomosis (Reconnection between blood vessels)
Note the fine black sutures and precise interspacing to allow for free flow of blood between the 2 connectected blood vessels.  These sutures are finer than human hair.  The top, purple vessel is the Vein; the smaller, lighter pink vessel is the Artery.  Reconnecting these blood vessels takes significant skill and patience. 

The temperment of a Plastic Surgeon who performs Microsurgery is different from the average surgeon. Focused intensity, absolute precision (there is little margin of error for a microsurgical blood vessel connection to avoid a blood clot), creativity and the steadiest of hands are basic hallmarks.  There is a reason why Reconstructive MicroPlastic Surgeons are a rare breed.

Sunday, January 10, 2010

What is an SIEA Flap?

The SIEA Flap is a pure abdominal skin and fat flap.  SIEA stands for Superficial Inferior Epigastric Artery.  This blood vessel system comes from the same branches of the DIEP flap, however, it is more superficial.    It allows the surgeons to use the skin and fat from the abdomen (tummy tuck) tissue and blood vessel without having to enter the abdominal wall fascia.  It is the most IDEAL flap for breast reconstruction in terms of donor site morbidity (the process of taking from one area to fix a different area).    However, not every patient has this particular blood vessel system, somewhere around 40% of the time these blood vessels exist.  When the blood vessels do exist, another 20% may not be usable because of their size.   The great advantage of this flap is that the abdominal wall is not "touched" and therefore the rectus muscles (six pack muscles on the abdomen), are not touched.  The disadvantage is that the blood vessels can be quite small the blood flow through the tissue can be variable.  The success of this flap depends upon your body's anatomy and surgeon experience and technical expertise.

We can perform a color duplex ultrasound at the initial evaluation to determine if you are candidate for this flap procedure.

Note the Blood Vessels (SIEA System) over the blue background.  These are more superficial than the DIEP system.