PMC5811279_01
Defect following resection.
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F1
The resultant defect measured 18 x 18 cm (Fig. 1).
Flap anatomy before harvest. LcDIEA, left cephalad deep inferior epigastric artery/vein; LDIEA, left deep inferior epigastric artery/vein; LDIEP, left deep inferior epigastric artery perforator; RcDIEA, right cephalad deep inferior epigastric artery/vein; RDIEA, right deep inferior epigastric artery/vein; RDIEP, right deep inferior epigastric artery perforator.
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F2
A 30 x 18 cm bipedicle, DIEP flap with flow-through intraflap anastomosis was designed (Fig. 2).
Microsurgically engineered bilateral DIEP flap with intra-flap flow-through anastomosis. LcDIEA, left cephalad deep inferior epigastric artery/vein; LDIEA, left deep inferior epigastric artery/vein; LDIEP, left deep inferior epigastric artery perforator; RcDIEA, right cephalad deep inferior epigastric artery/vein; RDIEA, right deep inferior epigastric artery/vein; RDIEP, right deep inferior epigastric artery perforator. RIJ, right internal jugular vein; RFA, right facial artery.
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F3
The caudal left DIEP vessels were anastomosed to the cephalic continuation of the right DIEP vessels (Fig. 3).
Flap anatomy at inset. Donor/recipient arterial and venous anastomoses (solid arrow), intra-flap right cephalad deep inferior epigastric artery/vein to left deep inferior epigastric artery/vein anastomoses (dashed arrow).
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F4
The lateral zone was trimmed off both hemiabdominal flaps and inset to fit the defect (Fig. 4).