Mehrara Babak J, Santoro Timothy, Smith Andrew, Arcilla Eric A, Watson James P, Shaw William W, Da Lio Andrew L
Department of Surgery, UCLA Medical Center, Los Angeles, CA, USA.
Plast Reconstr Surg. 2003 Aug;112(2):448-55. doi: 10.1097/01.PRS.0000070487.94201.30.
The lack of adequate recipient vessels often complicates microvascular breast reconstruction in patients who have previously undergone mastectomy and irradiation. In addition, significant size mismatch, particularly in the outflow veins, is an important contributor to vessel thrombosis and flap failure. The purpose of this study was to review the authors' experience with alternative venous outflow vessels for microvascular breast reconstruction. In a retrospective analysis of 1278 microvascular breast reconstructions performed over a 10-year period, the authors identified all patients in whom the external jugular or cephalic veins were used as the outflow vessels. Patient demographics, flap choice, the reasons for the use of alternative venous drainage vessels, and the incidence of microsurgical complications were analyzed. The external jugular was used in 23 flaps performed in procedures with 22 patients. The superior gluteal and transverse rectus abdominis musculocutaneous (TRAM) flaps were used in the majority of the cases in which the external jugular vein was used (72 percent gluteal, 20 percent TRAM flap). The need for alternative venous outflow vessels was usually due to a significant vessel size mismatch between the superior gluteal and internal mammary veins (74 percent). For three of the external jugular vein flaps (13 percent), the vein was used for salvage after the primary draining vein thrombosed, and two of three flaps in these cases were eventually salvaged. In three patients, the external jugular vein thrombosed, resulting in two flap losses, while the third was salvaged using the cephalic vein. A total of two flaps were lost in the external jugular vein group. The cephalic vein was used in 11 flaps (TRAM, 64.3 percent; superior gluteal, 35.7 percent) performed in 11 patients. In five patients (54.5 percent), the cephalic vein was used to salvage a flap after the primary draining vein thrombosed; the procedure was successful in four cases. In three patients, the cephalic vein thrombosed, resulting in two flap losses. One patient suffered a thrombosis after the cephalic vein was used to salvage a flap in which the external jugular vein was initially used, leading to flap loss, while a second patient experienced cephalic vein thrombosis on postoperative day 7 while carrying a heavy package. There was only one minor complication attributable to the harvest of the external jugular or cephalic vein (small neck hematoma that was aspirated), and the resultant scars were excellent. The external jugular and cephalic veins are important ancillary veins available for microvascular breast reconstruction. The dissection of these vessels is straightforward, and their use is well tolerated and highly successful.
对于先前接受过乳房切除术和放疗的患者，缺乏足够的受区血管常常使微血管乳房重建变得复杂。此外，明显的尺寸不匹配，尤其是在流出静脉中，是血管血栓形成和皮瓣坏死的重要原因。本研究的目的是回顾作者使用替代静脉流出血管进行微血管乳房重建的经验。在对10年间进行的1278例微血管乳房重建手术的回顾性分析中，作者确定了所有使用颈外静脉或头静脉作为流出血管的患者。分析了患者的人口统计学资料、皮瓣选择、使用替代静脉引流血管的原因以及显微外科并发症的发生率。22例患者的手术中使用了23个皮瓣的颈外静脉。在大多数使用颈外静脉的病例中采用了臀上动脉穿支皮瓣和腹直肌横形肌皮瓣（TRAM皮瓣）（72%为臀上动脉穿支皮瓣，20%为TRAM皮瓣）。需要替代静脉流出血管通常是由于臀上静脉和胸廓内静脉之间存在明显的血管尺寸不匹配（74%）。对于3个颈外静脉皮瓣（13%），在主要引流静脉血栓形成后使用该静脉进行挽救，其中3个皮瓣中有2个最终得以挽救。3例患者的颈外静脉发生血栓形成，导致2个皮瓣坏死，而第3个皮瓣使用头静脉得以挽救。颈外静脉组共有2个皮瓣坏死。11例患者的手术中使用了11个皮瓣（TRAM皮瓣占64.3%；臀上动脉穿支皮瓣占35.7%）的头静脉。5例患者（54.5%）在主要引流静脉血栓形成后使用头静脉挽救皮瓣；4例手术成功。3例患者的头静脉发生血栓形成，导致2个皮瓣坏死。1例患者在使用头静脉挽救最初使用颈外静脉的皮瓣后发生血栓形成，导致皮瓣坏死，而另1例患者在术后第7天搬运重物时发生头静脉血栓形成。颈外静脉或头静脉取材仅出现1例轻微并发症（抽吸治疗的小颈部血肿），且遗留的瘢痕效果良好。颈外静脉和头静脉是微血管乳房重建可用的重要辅助静脉。这些血管的解剖操作简单，使用耐受性良好且成功率高。
