Microcirculation and reinnervation in breast reconstruction

using deep inferior epigastric artery perforator flaps

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Dissertation for the degree of PhD 14th of June 2013.

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The thesis was based on clinical studies evaluating different aspects of breast reconstruction using the DIEAP (deep inferior epigastric artery perforator) flap. Today it is a standard procedure in breast reconstruction using free tissue transfer. The flap was first described two decades ago. Ever since, the DIEAP flap procedure has been constantly refined through extensive clinical use and from meticulous studying of vascular anatomy. However, there was still aspects of cutaneous reinnervation and microcirculation of the DIEAP flap that needed further investigation.

This inspired dr. Tindholdt and his group to evaluate a number of patients who were either planned for secondary breast reconstruction after mastectomy or patients who already had breast reconstruction with a DIEAP flap procedure. Their studies were divided in two. In the first part they looked at spontaneous reinnervation of the skin in the DIEAP flap and within the margins of the abdomen. They used Semmes-Weinstein monofilaments to evaluate pressure sensitivity. In the second part they evaluated the microcirculation of the DIEAP flap by measuring the skin perfusion during surgery and postoperatively using laser Doppler perfusion imaging.

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I

Tindholdt TT, Tønseth KA. Spontaneous reinnervation of deep inferior epigastric artery perforator flaps after secondary breast reconstruction. Scand J Plast Reconstr Surg Hand Surg 2008; 42(1): 28-31.

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II

Tindholdt TT, Tønseth KA. Donor site sensitivity after breast reconstruction with deep inferior epigastric artery perforator flap. Ann Plast Surg 2009; 63(2): 143-7.

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III

Tindholdt TT, Saidian S, Tønseth K. Microcirculatory evaluation of deep inferior epigastric artery perforator flaps with laser Doppler perfusion imaging in breast reconstruction. J Plast Surg Hand Surg 2011; 45(3): 143-7.

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IV

Tindholdt TT, Saidian S, Pripp AH, Tønseth KA. Monitoring microcirculatory changes in the deep inferior epigastrica artery perforator flap with laser Doppler perfusion imaging. Ann Plast Surg 2011: 67: 139-42.