Suk‐Ho Moon

Background It is important to include as many perforators as possible in order to enhance the vascularity of a deep inferior epigastric perforator (DIEP) flap. However, the rectus muscle must be transected transversely, which prevents suturing and can cause a defect along the same line as the muscle‐sparing procedure. When harvesting the DIEP flap, no specific method was suggested to solve these muscle defects. We found that by transecting the rectus muscle transversely, the muscle could be sutured in the tendinous area more easily while maintaining muscle function. The purpose of this study is to confirm the long‐term recovery of the rectus abdominis muscle through the volume change after DIEP flap using this tendinous transection and suture method. Patients and Methods A retrospective review of 28 patients who underwent unilateral breast reconstruction using a DIEP flap and the tendinous transection method for multiple perforators between May 2018 and April 2020 was conducted. The preoperative and postoperative volumes of the rectus abdominis muscle were estimated both the harvest and opposite sides. Results The preoperative and postoperative muscle volumes from the harvest side were 50.08 ± 8.71 cm 3 and 48.56 ± 8.61 cm 3 , respectively. The volume difference was 1.522 cm 3 decrease, which was not statistically significant ( p = .070). The preoperative and postoperative muscle volumes from the opposite side were 50.50 ± 8.15 cm 3 and 50.08 ± 8.18 cm 3 , respectively. The volume difference was 0.434 cm 3 increase and was not statistically significant ( p = .064). Postoperative volume changes in the rectus muscle were not statistically significant on either side. Conclusion The tendinous transection method in the DIEP flap procedure did not significantly affect postoperative rectus muscle volume. Therefore, we expect this harvest method to allow DIEP flap reconstruction that includes multiple perforators and complete donor muscle recovery.

Background Use of coupling devices in microvascular anastomosis continues to increase, but it is not yet actively used in end‐to‐side (ETS) anastomosis because there is no standard method. Therefore, we propose an easy and time‐saving ETS micro‐anastomosis method using coupling devices in head and neck reconstruction and compare it with the conventional suture method. Materials and Methods We retrospectively reviewed 30 consecutive cases (43 anastomoses) of ETS anastomosis in head and neck reconstruction from 2018 to 2022. Patient characteristics, operative details, and anastomosis time were evaluated. When using the coupling device, a cross incision was created in the recipient vessel to form vascular flaps. By pulling the flaps out of the ring, the intact vessel lining was fixed. Other procedures were the same as for a traditional anastomosis. Results The mean anastomosis time was 12.81 min (range, 6.7–24.87) for the suture and 4.96 min (range, 2.02–9.4) for the coupling device, a statistically significant difference ( p ‐value <.00005). There was no venous insufficiency or flap failure with either method. Conclusions ETS venous anastomosis using the coupling device is an easy‐to‐use, safe, and timesaving procedure for head and neck reconstruction.