Holm Charlotte, Mayr Martina, Höfter Eugen, Ninkovic Milomir
Department of Plastic, Reconstructive, and Hand Surgery, Klinikum Bogenhausen, Technical University Munich, Munich, Germany.
Plast Reconstr Surg. 2006 Jan;117(1):37-43. doi: 10.1097/01.prs.0000185867.84172.c0.
The Hartrampf perfusion zones of the lower abdominal flap are generally accepted. They were empirically based on the clinical impression of the perfusion in the first 16 unipedicled transverse rectus abdominis musculocutaneous flaps and have been uncritically adopted for the free transverse rectus abdominis musculocutaneous and the free deep inferior epigastric perforator (DIEP) flap. Scientific data proving the validity of these perfusion zones do not exist. The objective of this study was to evaluate and quantitatively assess the perfusion zones of the DIEP flap.
In a clinical, prospective study of 15 patients undergoing DIEP flap breast reconstruction, tissue perfusion was intraoperatively assessed using the method of laser-induced fluorescence of indocyanine green.
Perfusion of zones I, II, and III was seen 25, 41, and 32 seconds, respectively, after injection, and the perfusion index constituted 76, 25, and 47 percent (median) of normal tissue. Perfusion of zone IV was completely absent in five patients (33 percent); in the remaining patients, it was dramatically decreased (5 percent) and occurred with a delay of 67 seconds.
On the basis of the results of this study, the Hartrampf concept of a centrally perfused skin ellipse with declining perfusion of its peripheral ends is wrong and should be revised. Instead, one should think of the lower abdominal flap as two halves separated by the midline. The ipsilateral half has an axial pattern of perfusion; the contralateral half shows a random-pattern, individually variable blood supply. Therefore, the classic Hartrampf zones should be rearranged, switching zones II and III.
下腹皮瓣的哈特朗普法灌注区已被普遍接受。它们基于对最初16例单蒂腹直肌肌皮瓣灌注情况的临床印象，未经严格验证就被应用于游离腹直肌肌皮瓣和游离腹壁下动脉穿支（DIEP）皮瓣。目前尚无科学数据证明这些灌注区的有效性。本研究的目的是评估并定量分析DIEP皮瓣的灌注区。
在一项对15例行DIEP皮瓣乳房重建术患者的临床前瞻性研究中，术中采用吲哚菁绿激光诱导荧光法评估组织灌注情况。
注射后，I区、II区和III区分别在25秒、41秒和32秒出现灌注，灌注指数分别占正常组织的76%、25%和47%（中位数）。IV区在5例患者（33%）中完全无灌注；在其余患者中，灌注显著降低（5%），且延迟至67秒出现。
基于本研究结果，哈特朗普关于中央灌注的皮肤椭圆且其外周端灌注递减的概念是错误的，应予以修正。相反，应将下腹皮瓣视为由中线分隔的两半。同侧半具有轴型灌注模式；对侧半显示随机型、个体可变的血供。因此，经典的哈特朗普区应重新划分，将II区和III区互换。
