London, Ontario, Canada From the Divisions of Cardiac Surgery and Plastic Surgery, University of Western Ontario.
Plast Reconstr Surg. 2011 May;127(5):1783-1789. doi: 10.1097/PRS.0b013e31820cf300.
Autologous free flap breast reconstruction using the internal mammary artery is common; however, its use may compromise treatment of occult coronary artery disease. The authors investigated whether internal mammary artery harvest for breast reconstruction is compatible with future use for coronary bypass.
An anatomic analysis of 10 preserved female cadavers was performed. Internal mammary artery measurements, including the length from its origin to the third, fourth, and fifth intercostal spaces, were taken, and the minimum length required to reach the left anterior descending coronary artery was determined.
The left internal mammary artery reached the left anterior descending target at a mean length of 10.0 cm. The mean lengths to the left third, fourth, and fifth intercostal spaces were 8.2 cm, 11.3 cm, and 13.7 cm, respectively, on the left, and 7.6 cm, 10.7 cm, and 13.2 cm, respectively, on the right. The right internal mammary artery reached the left anterior descending target at a mean of 12.0 cm.
The left internal mammary artery was found to reach the estimated coronary target by the level of the fourth intercostal space consistently, while the right was more variable and required a greater length. If the fourth intercostal space was used to harvest the internal mammary artery, the length necessary for in situ coronary bypass surgery is preserved on the left, and may still be used as a free graft on the right.
自体游离皮瓣乳房重建术常采用内乳动脉，但可能会影响隐匿性冠状动脉疾病的治疗。作者研究了内乳动脉用于乳房重建是否与日后用于冠状动脉旁路移植术兼容。
对 10 具女性尸体标本进行解剖分析。测量内乳动脉的长度，包括从起点到第三、第四和第五肋间隙的长度，并确定到达左前降支所需的最小长度。
左侧内乳动脉的平均长度为 10.0cm 到达左前降支目标。左侧第三、第四和第五肋间隙的平均长度分别为 8.2cm、11.3cm 和 13.7cm，右侧分别为 7.6cm、10.7cm 和 13.2cm。右侧内乳动脉的平均长度为 12.0cm 到达左前降支目标。
左侧内乳动脉始终能到达第四肋间隙水平的估计冠状动脉靶标，而右侧则更具变异性，需要更长的长度。如果在第四肋间隙采集内乳动脉，左侧可保留原位冠状动脉旁路手术所需的长度，右侧仍可作为游离移植物使用。
