Brussels and Ghent, Belgium From the Department of Plastic and Reconstructive Surgery, University Hospital, Brussels; and Ghent University Hospital.
Plast Reconstr Surg. 2012 Apr;129(4):797-805. doi: 10.1097/PRS.0b013e3182450a8f.
Abdominal incisions and their subsequent scarring alter the vascular architecture of the abdominal pannus. This is of significance when reconstructing the breast with the deep inferior epigastric perforator (DIEP) flap. This study aimed to objectively investigate the impact of the lower abdominal Pfannenstiel scar in utilizing the DIEP flap.
A retrospective study of breast reconstruction with DIEP flaps was conducted on patients who had a Pfannenstiel scar (n = 36) compared with patients who did not (n = 36). Computed tomography angiograms were analyzed for the numbers, positions, and dimensions of perforator vessels. Influence of the scar on the reconstructive outcome was assessed.
The number of perforators was greater in the control group (mean, 9.14) compared with the study group (mean, 8.3) but was not significant, with marginal significance (p = 0.09). The percentage of found perforators with 4 mm or greater was significantly higher in the study group than in the control group (21.7 percent compared with 14.3 percent, respectively; p = 0.04). The position of perforators was more or less the same, and complications were also comparable in both groups.
Pfannenstiel incisions result in undermining of the lower abdominal apron and, in most cases, division of the superficial epigastric vessels. This results in "ischemic preconditioning" of the flap, as has been evidenced by the increased dimensions of the perforators. Hence, flaps raised from these abdomens are not only safe but may even be better vascularized.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
腹部切口及其随后的瘢痕改变了腹部脂肪垫的血管结构。在使用深部下腹壁穿支皮瓣（DIEP）进行乳房重建时，这一点非常重要。本研究旨在客观研究下腹部 Pfannenstiel 瘢痕对 DIEP 皮瓣利用的影响。
对接受 DIEP 皮瓣乳房重建的患者进行回顾性研究，其中有 Pfannenstiel 瘢痕（n = 36）的患者与无 Pfannenstiel 瘢痕（n = 36）的患者进行比较。对计算机断层血管造影进行分析，以确定穿支血管的数量、位置和尺寸。评估瘢痕对重建结果的影响。
对照组（平均 9.14 个）的穿支数量多于研究组（平均 8.3 个），但差异无统计学意义（p = 0.09）。研究组中 4 毫米或更大的穿支发现率明显高于对照组（分别为 21.7%和 14.3%，p = 0.04）。穿支的位置或多或少相同，两组的并发症也相当。
Pfannenstiel 切口导致下腹围裙的削弱，并且在大多数情况下，浅层腹壁血管的分割。这导致皮瓣的“缺血预处理”，正如穿支尺寸的增加所证明的那样。因此，从这些腹部提起的皮瓣不仅安全，而且可能甚至更具血管化。
临床问题/证据水平：治疗，III。
