The Taylor Lab, Department of Anatomy and Neurosciences, University of Melbourne, Parkville, Victoria, Australia.
PLoS One. 2012;7(5):e36367. doi: 10.1371/journal.pone.0036367. Epub 2012 May 9.
Mastectomies are one of the most common surgical procedures in women of the developed world. The gracilis myocutaneous flap is favoured by many reconstructive surgeons due to the donor site profile and speed of dissection. The distal component of the longitudinal skin paddle of the gracilis myocutaneous flap is unreliable. This study quantifies the fasciocutaneous vascular territories of the gracilis flap and offers the potential to reconstruct breasts of all sizes.
Twenty-seven human cadaver dissections were performed and injected using lead oxide into the gracilis vascular pedicles, followed by radiographic studies to identify the muscular and fasciocutaneous perforator patterns. The vascular territories and choke zones were characterized quantitatively using the 'Lymphatic Vessel Analysis Protocol' (LVAP) plug-in for Image J® software.
We found a step-wise decrease in the average vessel density from the upper to middle and lower thirds of both the gracilis muscle and the overlying skin paddle with a significantly higher average vessel density in the skin compared to the muscle. The average vessel width was greater in the muscle. Distal to the main pedicle, there were either one (7/27 cases), two (14/27 cases) or three (6/27 cases) minor pedicles. The gracilis angiosome was T-shaped and the maximum cutaneous vascular territory for the main and first minor pedicle was 35 × 19 cm and 34 × 10 cm, respectively.
Our findings support the concept that small volume breast reconstructions can be performed on suitable patients, based on septocutaneous perforators from the minor pedicle without the need to harvest any muscle, further reducing donor site morbidity. For large reconstructions, if a 'T' or tri-lobed flap with an extended vertical component is needed, it is important to establish if three territories are present. Flap reliability and size may be optimized following computed tomographic angiography and surgical delay.
乳房切除术是发达世界女性最常见的手术之一。由于供区情况和解剖速度，许多重建外科医生更喜欢使用腹直肌肌皮瓣。腹直肌肌皮瓣的纵向皮瓣远端部分不可靠。本研究量化了腹直肌皮瓣的筋膜皮血管区域，并为所有大小的乳房重建提供了潜力。
对 27 具人体尸体进行解剖，并将氧化铅注入腹直肌血管蒂中，然后进行放射学研究以确定肌肉和筋膜皮穿支模式。使用 Image J®软件的“淋巴管分析协议”（LVAP）插件对血管区域和梗塞区域进行定量描述。
我们发现，腹直肌和上覆皮瓣的中上三分之一的平均血管密度呈逐步下降趋势，皮瓣的平均血管密度明显高于肌肉。肌肉的平均血管宽度更大。在主蒂远端，有一个（7/27 例）、两个（14/27 例）或三个（6/27 例）小蒂。腹直肌血管分布区呈 T 形，主蒂和第一小蒂的最大皮肤血管区域分别为 35×19cm 和 34×10cm。
我们的研究结果支持这样一种观点，即基于小蒂的穿支筋膜皮瓣，可以为合适的患者进行小体积乳房重建，而无需采集任何肌肉，进一步降低供区并发症的发生率。对于大的重建，如果需要“T”形或三叶瓣，并延长垂直部分，则重要的是要确定是否存在三个区域。在进行计算机断层血管造影和手术延迟后，可能会优化皮瓣的可靠性和大小。
