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The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace rib‐sparing internal mammary vessel exposure
Author(s) -
Khoo Anna,
RosichMedina Anais,
Woodham Amandine,
Jessop Zita M.,
Candia Michele,
Malata Charles M.
Publication year - 2014
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22238
Subject(s) - medicine , breast reconstruction , microsurgery , intercostal space , surgery , free flap , body mass index , nuclear medicine , breast cancer , cancer
Purpose of the study Rib‐sparing internal mammary vessel (IMV) exposure in breast reconstruction is becoming common, with a smaller space in which to perform the microanastomoses. The objectives were to determine whether patient height could be used as a proxy measurement for intercostal distance (ICD), assess whether the complication rate or the flap ischemia time are affected in such surgery, and provide anatomical data about ICDs. Methods Data were collected from 95 consecutive patients (109 breasts) undergoing free flap breast reconstruction using rib‐sparing vessel exposure over a 3‐year period by one surgeon. Pearson's product moment correlation coefficient was used to assess the relation between height and ICD, body mass index (BMI), operative times, and flap outcomes. Results There was no correlation between patient height and ICD ( r = 0.087), age, BMI, recipient vessel preparation time, and flap ischemia time. Conclusion Being able to predict patients with a small ICD in whom microsurgery may be more challenging can influence surgical planning. The anatomy of the intercostal spaces is variable and was not predictable in relation to height, BMI, or age. Height was not a reliable proxy for ICD and where there is a concern about the available ICD it is suggested that it is measured directly through preoperative imaging. This study found no increase in the complication rate and flap ischemia time using the rib‐sparing IMV exposure technique. © 2014 Wiley Periodicals, Inc. Microsurgery 34:448–453, 2014.