Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center at Dallas.
Plast Reconstr Surg. 2012 Feb;129(2):331-340. doi: 10.1097/PRS.0b013e31823ae9a3.
Breast reconstruction using the deep inferior epigastric perforator (DIEP) flap is becoming more common and can help reduce donor site morbidity. The authors proposed that dissection of the deep inferior epigastric artery (DIEA) and vein (DIEV) to their external iliac source may not be required for safe flap transfer.
Sixteen whole fresh cadaveric hemiabdomens were used to dissect transverse abdominal-based flaps. Latex injection of the DIEA system was carried out, and the diameters of the DIEA/DIEV vessels were assessed at various points along the course of the pedicle from the origin to the perforator. A clinical study of 26 patients who underwent a short and ultrashort pedicle DIEP flaps was carried out.
The average DIEA and DIEV vessel diameters were relatively similar from the external iliac origin to a point just caudal to the bifurcation. At the lateral rectus edge, the average DIEA diameter was 3.2 mm, and the DIEV diameter was 3.1 mm. The average pedicle length obtained with classic DIEP dissection was 16.9 cm, short-pedicle DIEP dissection 10.4 cm, ultrashort technique 8.1 cm, and free TRAM technique 6.5 cm. Venous injection study demonstrated rich venous interconnections between both venae comitantes. In their clinical study, the authors were able to achieve average pedicle lengths of 11.0 cm when transecting cranial to the lateral edge of the rectus, with average diameters of 2.5 mm (artery) and 2.9 mm (vein).
Transection of the DIEA/DIEV pedicle at the lateral rectus edge or more proximally is safe and can help reduce operative time and donor-site morbidity.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
采用腹壁下动脉穿支皮瓣（DIEP）进行乳房再造的方法越来越常见，并且可以帮助减少供区的发病率。作者提出，为了安全地转移皮瓣，可能不需要解剖腹壁下动脉（DIEA）和静脉（DIEV）至其髂外源。
使用 16 具全尸半腹部进行横切口腹部皮瓣解剖。对 DIEA 系统进行乳胶注射，并评估在从起点到穿支的蒂部沿线各个部位的 DIEA/DIEV 血管直径。对 26 例行短蒂和超短蒂 DIEP 皮瓣的患者进行了临床研究。
从髂外起点到分叉后稍下方的一点，DIEA 和 DIEV 血管直径相对相似。在腹直肌外侧缘，DIEA 直径平均为 3.2mm，DIEV 直径为 3.1mm。采用经典 DIEP 解剖获得的平均蒂长为 16.9cm，短蒂 DIEP 解剖为 10.4cm，超短技术为 8.1cm，游离 TRAM 技术为 6.5cm。静脉注射研究表明，两条伴行静脉之间存在丰富的静脉吻合。在他们的临床研究中，作者在横切腹直肌外侧缘的颅侧时，能够达到平均蒂长 11.0cm，平均直径为 2.5mm（动脉）和 2.9mm（静脉）。
在腹直肌外侧缘或更靠近近侧横切 DIEA/DIEV 蒂是安全的，并且可以帮助减少手术时间和供区的发病率。
临床问题/证据水平：治疗，IV。
