Tran Nho V, Buchel Edward W, Convery Phyllis A
Rochester, Minn. From the Plastic Surgery Division, Mayo Clinic.
Plast Reconstr Surg. 2007 Apr 15;119(5):1397-1405. doi: 10.1097/01.prs.0000256045.71765.96.
The deep inferior epigastric perforator (DIEP) flap has become a popular option for breast reconstruction because of reduced donor-site morbidity. As the number of perforators per flap is reduced, vascular compromise may develop. Venous congestion can occur despite patent primary venous anastomosis.
A prospective series of 100 consecutive DIEP flaps in breast reconstruction were studied for vascular problems and outcomes.
Ninety-nine flaps were successful. No arterial compromise occurred. Overall, venous congestion occurred in 15 flaps. Eleven flaps developed intraoperative venous congestion, but only five flaps required vascular bypass between the superficial epigastric vein and chest wall vein for additional drainage. One flap was lost because of the authors' failure to recognize and manage inadequate venous outflow by the chosen perforator vein. One flap suffered major fat necrosis because of postoperative thrombosis of the saphenous vein bypass. Overall, fat necrosis occurred in 12 flaps.
DIEP venous congestion, despite patent primary venous anastomosis, occurs in 5 percent of these flaps and can be managed successfully by a second venous bypass between the superficial epigastric vein and any chest wall vein. Failure to recognize and manage this can cause flap loss.
由于供区并发症减少，腹壁下深动脉穿支（DIEP）皮瓣已成为乳房重建的常用选择。随着每个皮瓣穿支数量的减少，可能会出现血管受损情况。尽管主要静脉吻合口通畅，但仍可能发生静脉淤血。
对连续100例用于乳房重建的DIEP皮瓣进行前瞻性研究，观察血管问题及结果。
99例皮瓣手术成功。未发生动脉受损情况。总体而言，15例皮瓣出现静脉淤血。11例皮瓣在术中出现静脉淤血，但仅5例皮瓣需要在腹壁浅静脉与胸壁静脉之间进行血管搭桥以增加引流。1例皮瓣因术者未识别并处理所选穿支静脉的静脉流出不足而失败。1例皮瓣因大隐静脉搭桥术后血栓形成而发生严重脂肪坏死。总体而言，12例皮瓣发生脂肪坏死。
尽管主要静脉吻合口通畅，但5%的DIEP皮瓣仍会出现静脉淤血，可通过在腹壁浅静脉与任何胸壁静脉之间进行二次静脉搭桥成功处理。未能识别和处理这一情况可能导致皮瓣失败。
