Saint-Cyr Michel, Youssef Adel, Bae Hyung Woon, Robb Geoffrey L, Chang David W
Houston, Texas From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2007 Jun;119(7):1993-2000. doi: 10.1097/01.prs.0000260636.43385.90.
Over the years, the authors' preferred recipient vessels for microvascular autologous breast reconstruction have changed from the thoracodorsal to the internal mammary vessels.
From 1994 to 2004, 1483 microvascular autologous breast reconstructions were performed in 1168 patients at the authors' institution. Potential factors involved in the selection of the recipient vessels were evaluated and compared between the thoracodorsal and internal mammary groups. Rates of recipient vessel unusability and flap-related complications were also analyzed and compared between the two groups.
The mean patient age was 48 years, and the mean follow-up time was 1.5 years. The vessel conversion rate was 2.8 percent for the thoracodorsal group and 1.9 percent for the internal mammary group. Preoperative radiotherapy and previous axillary node dissection were significantly associated with thoracodorsal vessel conversion (odds ratios, 4.7 and 2.6, respectively). The overall flap-related complication rate (12.6 percent versus 8.6 percent) and specific flap-related complications, including flap loss (2.6 percent versus 3.8 percent), vessel thrombosis (3.7 percent versus 5.0 percent), fat necrosis (4.5 percent versus 2.6 percent), infection (0.7 percent versus 0.7 percent), and hematoma (1.6 percent versus 1.9 percent), were comparable between the two groups, but the flap seroma rate was significantly higher in the thoracodorsal group (4.0 percent versus 0.7 percent; odds ratio, 4.2).
In the authors' experience, use of internal mammary vessels is safe, with low rates of vessel conversion and flap-related complications.
多年来，作者进行微血管自体乳房重建时首选的受区血管已从胸背血管转变为胸廓内血管。
1994年至2004年，作者所在机构对1168例患者进行了1483例微血管自体乳房重建。评估并比较了胸背血管组和胸廓内血管组在选择受区血管时涉及的潜在因素。还分析并比较了两组受区血管不可用率和皮瓣相关并发症发生率。
患者平均年龄为48岁，平均随访时间为1.5年。胸背血管组的血管转换率为2.8%，胸廓内血管组为1.9%。术前放疗和既往腋窝淋巴结清扫与胸背血管转换显著相关（优势比分别为4.7和2.6）。两组的总体皮瓣相关并发症发生率（12.6%对8.6%）以及特定的皮瓣相关并发症，包括皮瓣坏死（2.6%对3.8%）、血管血栓形成（3.7%对5.0%）、脂肪坏死（4.5%对2.6%）、感染（0.7%对0.7%）和血肿（1.6%对1.9%）相当，但胸背血管组的皮瓣血清肿发生率显著更高（4.0%对0.7%；优势比为4.2）。
根据作者的经验，使用胸廓内血管是安全的，血管转换率和皮瓣相关并发症发生率较低。
