Eom Jin Sup, Sun Sang-Hoon, Lee Taik Jong
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388–1 Pungnap-dong, Songpa-gu, Seoul, South Korea.
Ann Plast Surg. 2011 Nov;67(5):505-9. doi: 10.1097/SAP.0b013e31820bcd5f.
There have been many methods to use the superficial inferior epigastric vein (SIEV) for improvement of flap circulation during breast reconstruction with free abdominal flap. If the SIEV is used for the purpose of adding another draining route, selection of ideal recipient vein is a crucial step. We reviewed our experiences of using the SIEV as additional vein in free transverse rectus abdominis musculocutaneous or deep inferior epigastric artery perforator breast reconstruction to find out the ideal recipient vein for SIEV. Between April 2006 and July 2010, 153 cases of breast reconstruction were performed using free transverse rectus abdominis musculocutaneous or deep inferior epigastric artery perforator flaps. Additional SIEV anastomosis was performed in 45 cases with risk factors. First choice of the recipient vein was the lateral thoracic vein if the SIEV was placed laterally after the inset of the flap. If the lateral thoracic vein was ablated with lymph node dissection, the branch of the thoracoacromial vein was selected. If the SIEV was placed medially, the perforator of the internal mammary vein was used. No vascular compromise was observed in cases with additional SIEV anastomosis with those recipient veins, whereas 9 cases of flap-related complications were observed in the remaining 108 cases without additional SIEV anastomosis. The incidences of the venous congestion were significantly different between the 2 groups. Combination of the lateral thoracic vein, branch of the thoracoacromial vein, and the perforator of the internal mammary vein provided an excellent choice of the recipient vein for the SIEV with reliability and availability.
在游离腹直肌皮瓣乳房重建术中，已有多种利用腹壁浅静脉（SIEV）改善皮瓣血运的方法。若使用SIEV的目的是增加另一条引流途径，选择理想的受区静脉是关键步骤。我们回顾了在游离腹直肌横形肌皮瓣或腹壁下动脉穿支乳房重建术中将SIEV作为额外静脉使用的经验，以找出SIEV的理想受区静脉。2006年4月至2010年7月，共进行了153例游离腹直肌横形肌皮瓣或腹壁下动脉穿支皮瓣乳房重建术。45例有危险因素的患者进行了额外的SIEV吻合。若皮瓣植入后SIEV位于外侧，首选的受区静脉是胸外侧静脉。若胸外侧静脉因淋巴结清扫而被切除，则选择胸肩峰静脉的分支。若SIEV位于内侧，则使用胸廓内静脉的穿支。与这些受区静脉进行额外SIEV吻合的病例未观察到血管受损，而其余108例未进行额外SIEV吻合的病例中观察到9例皮瓣相关并发症。两组静脉淤血的发生率有显著差异。胸外侧静脉、胸肩峰静脉分支和胸廓内静脉穿支的联合为SIEV提供了可靠且可用的理想受区静脉选择。
