St Andrew's Centre for Plastic Surgery and Burns, Chelmsford, UK.
J Plast Reconstr Aesthet Surg. 2012 Aug;65(8):1051-9. doi: 10.1016/j.bjps.2012.02.026. Epub 2012 Mar 17.
The DIEAP flap has gained popularity for breast reconstruction worldwide. Despite DIEAP flap arterial anatomy being well known, venous congestion is still an important complication and the literature on DIEAP flap venous anatomy is lacking. Venous drainage is less predictable and research on venous perforators is of increasing interest. The aim of this study was to investigate the anatomical distribution, diameters and relationships between arterial and venous perforators and their source vessels using Duplex ultrasonography, in order to evaluate the potential benefits of pre-operative evaluation of DIEAP flap venous perforators.
Prospectively, 140 patients undergoing DIEAP flap breast reconstruction, were pre-operatively assessed using Duplex ultrasonography for location and diameter of arterial and venous perforators, DIEA, DIEV, and SIEV. Perforators were plotted laterally and inferiorly from the umbilicus. Means were compared using t-tests. Pearson's correlation coefficients were calculated.
We identified 702 arterial and 355 venous perforators in 280 lower hemi-abdomens. No venous perforators were identified in 9 (6.5%) patients; none on the right in 25 (17.9%) and none on the left in 36 (25.7%). Venous perforators were larger on the right (p=0.031) but DIEV and SIEV diameters were not statistically different on either sides. The diameters of DIEA, DIEV, perforating arteries and veins were correlated, but unrelated to the diameter of the SIEV. When a medium/large perforator vein is identified first, there is a 93.5% chance of finding an associated medium/large perforator artery; this reduces to 69.8% when a medium/large perforator artery is first identified.
There is no correlation between the sizes of perforator veins and DIEV, and the size of the SIEV. Our data suggests that first identifying a medium/large venous perforator increases the chances of finding a better suitable perforator complex. Pre-operative evaluation of venous perforators may be of great interest for its potential clinical benefits.
DIEAP 皮瓣在全球范围内已广泛应用于乳房重建。尽管 DIEAP 皮瓣的动脉解剖结构已被充分了解，但静脉淤血仍然是一个重要的并发症，而且关于 DIEAP 皮瓣静脉解剖结构的文献还很缺乏。静脉引流的可预测性较低，因此静脉穿支的研究越来越受到关注。本研究旨在通过双功能超声检查，研究动脉和静脉穿支的解剖分布、直径以及它们与源血管之间的关系，以评估术前评估 DIEAP 皮瓣静脉穿支的潜在益处。
前瞻性地，对 140 例行 DIEAP 皮瓣乳房重建的患者进行术前评估，使用双功能超声检查确定动脉和静脉穿支、DIEA、DIEV 和 SIEV 的位置和直径。穿支从脐部外侧和下方进行绘图。使用 t 检验比较平均值。计算 Pearson 相关系数。
我们在 280 个下腹部中发现了 702 个动脉穿支和 355 个静脉穿支。9 名（6.5%）患者未发现静脉穿支；25 名（17.9%）右侧无静脉穿支，36 名（25.7%）左侧无静脉穿支。右侧静脉穿支较大（p=0.031），但 DIEV 和 SIEV 直径在两侧均无统计学差异。DIEA、DIEV、穿支动脉和静脉的直径相关，但与 SIEV 的直径无关。当首先识别到中等/大口径静脉穿支时，发现相关的中等/大口径动脉穿支的可能性为 93.5%；当首先识别到中等/大口径动脉穿支时，这一比例降至 69.8%。
穿支静脉的大小与 DIEV 和 SIEV 之间没有相关性。我们的数据表明，首先识别出中等/大口径的静脉穿支可以增加找到更合适的穿支复合体的机会。静脉穿支的术前评估可能因其潜在的临床益处而受到极大关注。
