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Plast Aesthet Res 2018;5:6 I http://dx.doi.org/10.20517/2347-9264.2018.08 Page 3 of 17

4. When free tissue transfer is not an option: complex traumatic lower extremity
reconstruction using perforator flaps

Ryan Kunkel, Christopher Demas

University of New Mexico Hospital

Perforator flaps have changed the approach to reconstructive dilemmas since their emergence on the
plastic surgery scene. This additional rung on the reconstructive ladder has led to new methods of closing
complicated lower extremity wounds. While arguably more versatile than traditional methods of lower
extremity reconstruction, they require tedious dissection and microsurgical techniques. It is important for
the plastic surgeon to be familiar with the application of perforator flaps, particularly when more traditional
methods of reconstruction are not viable or safe options. We present three cases of complicated lower
extremity wounds that were reconstructed with perforator flaps. The first case was a Grade IIIB tibia with a
22-cm soft tissue defect involving all three zones of the lower extremity. Renal and hepatic failure precluded
a prolonged microsurgical procedure. This was covered with a distally based posterior tibial perforator flap
and a gastrocnemius flap. The second case was a Grade IIIB tibia with open wound in the proximal and
middle third of the leg. The patient failed gastrocnemius and reverse sural flap by another surgeon and
was not a candidate for a free flap because of a recent STEMI. He was successfully reconstructed with
two flaps based on one posterior tibial perforator cluster. The third case was a grade IIIC tibia with 12-
cm segmental bone loss. Free tissue transfer was too risky because of a femoral vein thrombosis, which, if
propagated, would cause flap failure. Double opposing peroneal and posterior tibial perforator flaps were
used to successfully close the defect.

5. Oncoplastic nipple sparing mastectomy with immediate, implant-based reconstruction:

technique and outcomes

Sarah E. Sasor, Julia A. Cook, Tyler A. Evans, William A. Wooden, Sunil S.Tholpady, Michael W.
Chu, Juan Socas

Indiana University Division of Plastic & Reconstructive Surgery

Aim: Nipple sparing mastectomy (NSM) is a popular option for women with small, peripherally located
breast tumors. The procedure is oncologically safe in select patients but can be technically challenging in
large, ptotic breasts. In this study, we examine our experience with NSM using a Wise-pattern skin reduction
and nipple areola complex (NAC) preservation on an inferiorly based adipo-dermal pedicle.

Methods: A retrospective study of patients undergoing NSM at our institution over a six month period
was performed. All patients undergoing NSM with a Wise-pattern skin reduction, NAC repositioning,
and immediate, implant-based breast reconstruction were included. Variables collected included patient
demographics, smoking status, medical comorbidities and indication for mastectomy. Post-operative
outcomes were analyzed with respect to patient and tumor characteristics.

Results: Eight NSM’s were performed on five patients during the study period. Mean age and BMI
were 49 years and 29.1, respectively. No patients were current smokers. All breasts had grade 2 or
3 ptosis. Mean mastectomy weight was 878 grams. All patients had immediate reconstruction with