{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:13:31Z","timestamp":1787318011021,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T00:00:00Z","timestamp":1715126400000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Superficial inferior epigastric artery (SIEA) flap is often chosen to minimize postoperative complications such as abdominal pain and bulging. However, drawbacks, including a small diameter and a short pedicle, pose challenges in anastomosing or creating the lower pole of the breast. Here, we report a case of breast reconstruction using an SIEA flap with pedicle elongation via an arteriovenous loop (AV\u2010loop) using a contralateral superficial inferior epigastric vein (SIEV) graft. A 49\u2010year\u2010old woman underwent a left total mastectomy with the primary insertion of a tissue expander. Breast reconstruction using an SIEA flap with pedicle elongation was planned. The running pattern, pedicle length,\u00a0and diameter of bilateral SIEA\/SIEV and superficial circumflex iliac artery and vein (SCIA\/SCIV) were evaluated preoperatively using a 48\u2010MHz probe of ultra\u2010high\u2010frequency ultrasonography (Vevo MD ultrasound device, Fujifilm Visual Sonics, Amsterdam, the Netherlands). During the flap harvesting, the contralateral SIEV graft was harvested to create an AV\u2010loop for pedicle elongation. The 9\u2009cm graft was anastomosed to the left internal mammary artery and vein (IMA\/IMV). After the flap elevation, the created AV\u2010loop was divided at the midpoint and anastomosed to the pedicle of the SIEA flap. The SIEA flap, extended with a SIEV AV\u2010loop, facilitated the augmentation of the lower pole of the breast without the risk of pedicle kinking and pulling. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. The prolonged pedicle length via an AV\u2010loop prevents the pedicle kinking and allows for positioning the flap more freely, resulting in an aesthetically good breast contour by filling in the lower pole. The precise preoperative evaluation of the vessels using ultra\u2010high\u2010frequency ultrasonography facilitated meticulous planning. In cases where surgeons aim to minimize intraoperative and postoperative complications associated with other abdominal free flaps, this method may be considered a viable and promising option.<\/jats:p>","DOI":"10.1002\/micr.31183","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T04:53:28Z","timestamp":1715144008000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Breast reconstruction using a superficial inferior epigastric artery flap with pedicle elongation via an arteriovenous loop: A case report"],"prefix":"10.1002","volume":"44","author":[{"given":"Wataru","family":"Otsuka","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Koto\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-8094","authenticated-orcid":false,"given":"Ryo","family":"Karakawa","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Koto\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5427-817X","authenticated-orcid":false,"given":"Hidehiko","family":"Yoshimatsu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Koto\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6319-9019","authenticated-orcid":false,"given":"Tomoyuki","family":"Yano","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research  Koto\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjps.1999.3099"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000297634.53915.e5"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000135328.88101.53"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000004730"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001150"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198202000-00006"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2005.12.066"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/1538574411418843"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/1098-2752(2000)20:4<162::AID-MICR3>3.0.CO;2-L"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.1920110407"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002158"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31817d60b0"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000270282.92038.3f"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22185"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181823c15"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1736317"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1726395"}],"container-title":["Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/micr.31183","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T03:35:25Z","timestamp":1744428925000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/micr.31183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5]]},"references-count":17,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1002\/micr.31183"],"URL":"https:\/\/doi.org\/10.1002\/micr.31183","archive":["Portico"],"relation":{},"ISSN":["0738-1085","1098-2752"],"issn-type":[{"value":"0738-1085","type":"print"},{"value":"1098-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5]]},"assertion":[{"value":"2024-01-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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