Tokyo Women's Medical University, Department of Plastic and Reconstructive Surgery, Tokyo, Japan.
J Plast Reconstr Aesthet Surg. 2011 Jan;64(1):63-8. doi: 10.1016/j.bjps.2010.03.012. Epub 2010 Apr 14.
The superficial inferior epigastric artery (SIEA) flap consists of skin and subcutaneous fat with limited donor-site morbidity and has the potential to be very versatile - either as a thin flap without excessive fat tissue or as a voluminous flap for breast reconstruction. However, anatomical inter-individual variability often makes the choice of a free SIEA flap difficult. Imaging of small-calibre vessels is possible with the multi-detector-row computed tomography angiography (MDCTA) and to obtain the characteristics of the superficial inferior epigastric vascular anatomy, we investigated the superficial inferior epigastric system using MDCTA.
We investigated 17 patients who had abdominal wall MDCTA in preparation for a free flap procedure using either the deep inferior epigastric perforator (DIEP), SIEA or the groin flap. The visibility and anatomical characteristics including the branching pattern, the diameter, course of travel and layers were noted.
The SIEA was visible in 64.7% and, of these, 36.4% had a common trunk formation with the superficial circumflex iliac artery (SCIA), while 63.6% arose independently. The measured diameters were SIEA 1.6 ± 0.4mm, SCIA 1.4 ± 0.4mm, deep circumflex iliac artery (DCIA) 2.4 ± 0.4mm, DIEA 2.9 ± 0.4mm and superficial inferior epigastric vein (SIEV) 3.1 ± 0.5mm. The SIEA consistently coursed lateral to and deeper than the SIEV and also lateral to the DIEA.
MDCTA provided detailed three-dimensional information of the superficial inferior epigastric vascular system including the course and size of the SIEA. The information on vascular anatomy obtained with the MDCTA is valuable in the preoperative planning of the free SIEA flap and should be performed routinely.
浅表腹壁下动脉（SIEA）皮瓣包含皮肤和皮下脂肪，供区并发症少，且具有很大的通用性-可以作为没有过多脂肪组织的薄皮瓣，也可以作为用于乳房再造的大容量皮瓣。但是，解剖学上的个体间变异性常常使游离 SIEA 皮瓣的选择变得困难。多排螺旋 CT 血管造影（MDCTA）可以对小口径血管进行成像，为了获得 SIEA 血管解剖结构的特征，我们使用 MDCTA 对浅表腹壁下血管系统进行了研究。
我们对 17 例接受腹部壁 MDCTA 检查的患者进行了研究，这些患者正在准备进行游离皮瓣手术，包括深部腹壁下穿支皮瓣（DIEP）、SIEA 或腹股沟皮瓣。注意观察 SIEA 的可视性和解剖学特征，包括分支模式、直径、行程和层次。
SIEA 在 64.7%的患者中可见，其中 36.4%与旋髂浅动脉（SCIA）形成共同干，而 63.6%则独立出现。测量的直径为 SIEA 1.6±0.4mm、SCIA 1.4±0.4mm、旋髂深动脉（DCIA）2.4±0.4mm、DIEA 2.9±0.4mm 和腹壁下浅静脉（SIEV）3.1±0.5mm。SIEA 始终位于 SIEV 的外侧和深部，并位于 DIEA 的外侧。
MDCTA 提供了包括 SIEA 行程和大小在内的浅表腹壁下血管系统的详细三维信息。MDCTA 获得的血管解剖学信息对游离 SIEA 皮瓣的术前规划很有价值，应该常规进行。
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