3 years ago

Prélever un SIEP à la place d’un DIEP en reconstruction mammaire : note technique

Q. Bettex, C. Jaloux, M. Abellan Lopez, D. Casanova, B. Bertrand, C. Philandrianos

Publication date: Available online 27 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): Q. Bettex, C. Jaloux, M. Abellan Lopez, D. Casanova, B. Bertrand, C. Philandrianos

Résumé

La reconstruction mammaire par lambeau abdominal a évolué vers une diminution des séquelles du site donneur depuis la description du lambeau perforant de DIEP (pour Deep Inferior Epigastrique Perforator). De même épaisseur et de même surface, le lambeau de SIEA (pour Superficial Inferior Epigstrique Artery) ne nécessite pas, pour son prélèvement, d’ouverture de la gaine abdominale ni de dissection au travers des muscles grands droits, minimisant encore les séquelles. Cependant, il est peu utilisé en raison de la variabilité de sa vascularisation et d’un taux d’échec plus élevé que le DIEP dans la littérature. Nous pensons qu’il est tout de même raisonnable, dans certains cas, de prélever un SIEA à la place d’un DIEP. Nous présentons une note technique expliquant notre stratégie opératoire permettant de prélever un SIEA de façon fiable lorsque le calibre des vaisseaux le permet.

Summary

Breast reconstruction by abdominal flap has evolved to ensure minimal donor-site morbidity with the description of Deep Inferior Epigastric artery Perforator flap (DIEP flap). Being of the same thickness and the same surface, the Superficial Inferior Epigastric Artery flap (SIEA flap) does not require, for it harvesting, to open the abdominal fascia or to dissect through the muscles minimizing again donor-site sequelae. However, it is little used because of the variability of its vascularization and a higher failure rate than the DIEP in the literature. We believe that it is reasonable, in some cases, to harvest a SIEA flap instead of DIEP flap in mammary reconstruction. We present a technical note explaining our operative strategy for reliably taking a SIEA when the caliber of the vessels allows.

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