Baltimore, Md. From the Department of Plastic Surgery, The Johns Hopkins University.
Plast Reconstr Surg. 2011 Oct;128(4):225e-232e. doi: 10.1097/PRS.0b013e31821740ff.
Microvascular breast reconstruction often sacrifices the internal mammary artery by means of an end-to-end anastomosis. However, an end-to-side anastomosis to the internal mammary artery will maintain the option of using the internal mammary artery for future coronary artery bypass. The authors' goal was to show the feasibility and reliability of the end-to-side arterial anastomosis by comparing it with the end-to-end anastomosis in terms of associated ischemia time, flap weight, incidence of thrombosis and fat necrosis, and overall flap survival.
The authors reviewed the medical records of 22 consecutive patients who underwent 30 autologous breast reconstructions performed by one surgeon at The Johns Hopkins Hospital Avon Foundation Breast Center and whose deep inferior epigastric artery perforator or superficial inferior epigastric artery flap pedicles were anastomosed using an arterial end-to-side hand-sewn technique (15 anastomoses) or an arterial end-to-end hand-sewn technique (15 anastomoses). The authors compared the identified parameters and set the level of significance at the 0.05 alpha level.
The only significant difference between the end-to-side and end-to-end groups was mean ischemia time: 85.3±18.1 minutes (range, 55 to 113 minutes) and 64.4±23.6 minutes (range, 30 to 113 minutes), respectively.
Although ischemia times were increased in the end-to-side group, they remained within acceptable limits. Therefore, this technique is a reliable and technically feasible method of preserving the internal mammary artery system for future potential cardiac surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
微血管乳房重建术通常通过端端吻合来牺牲内乳动脉。然而，内乳动脉的端侧吻合将保留未来用于冠状动脉旁路移植术的内乳动脉的选择。作者的目标是通过比较端端吻合术，显示端侧动脉吻合术的可行性和可靠性，从缺血时间、皮瓣重量、血栓和脂肪坏死发生率以及整体皮瓣存活率等方面进行比较。
作者回顾了 22 例连续患者的病历，这些患者均由一名外科医生在约翰霍普金斯医院雅芳基金会乳房中心进行了 30 例自体乳房重建术，其深下腹动脉穿支或浅下腹动脉蒂通过动脉端端手工吻合（15 个吻合）或动脉端端手工吻合（15 个吻合）。作者比较了确定的参数，并将显著性水平设置为 0.05alpha 水平。
端端组和端侧组之间唯一的显著差异是平均缺血时间：85.3±18.1 分钟（范围，55 至 113 分钟）和 64.4±23.6 分钟（范围，30 至 113 分钟）。
尽管端侧组的缺血时间增加，但仍在可接受的范围内。因此，这种技术是一种可靠且技术可行的方法，可以保留内乳动脉系统，以备未来潜在的心脏手术。
临床问题/证据水平：治疗，III 级。
