Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076 Tübingen, Germany.
J Plast Reconstr Aesthet Surg. 2013 Jan;66(1):67-72. doi: 10.1016/j.bjps.2012.08.020. Epub 2012 Sep 13.
While the arterial perfusion of the anterior abdominal wall has been extensively described in the literature, little has been published on the venous drainage of the deep inferior epigastric flap (DIEP). The present study was performed to further clarify the venous drainage of DIEP flap, which remains a common vascular complication of this flap.
We assessed the efficiency of venous outflow on 19 patients undergoing DIEP flap breast reconstruction, determining relative haemoglobin concentration (rHB) as an indicator of venous congestion. After the flap had been isolated on the perforator vessels, a selective clamping and declamping of the single lateral and medial perforator was performed and several measurements were carried out using a micro-lightguide spectrophotometer device (O2C: Oxygen to See; LEA Medizintechnik, Gießen, Germany). In addition, the efficacy of venous supercharging with ipsilateral and contralateral superficial inferior epigastric veins (SIEVs) was quantified.
For the sake of simplicity, we applied the classic perfusion zones of the lower abdomen as suggested by Hartrampf (1983). Regardless of lateral or medial DIEP perforator veins, zone IV showed the least venous outflow, while we observed the highest drainage in zone I. There was no significant difference between the venous drainage of the two immediately adjacent zones II and III. Supercharging with the contralateral SIEV showed a significantly better venous drainage in the contralateral zones II and IV, whereas the ipsilateral SIEV did not present any significant improvement in the venous drainage of any zone.
This study evaluated the characteristics of the venous outflow of the DIEP flap, based on the single perforator and the SIEVs. Our findings revealed that zones II and III have a similar venous drainage regardless of the perforator veins used. The supercharging of the contralateral SIEV leads to an improved venous outflow compared to the ipsilateral SIEV. This may support surgeons in minimising venous complications and may improve the degree of DIEP flap survival.
尽管前腹壁的动脉灌注在文献中已得到广泛描述，但关于深部腹壁下血管蒂皮瓣（DIEP）的静脉引流却鲜有报道。本研究旨在进一步阐明 DIEP 皮瓣的静脉引流，这仍然是该皮瓣的一种常见血管并发症。
我们评估了 19 例行 DIEP 皮瓣乳房再造术患者的静脉回流效率，以相对血红蛋白浓度（rHB）作为静脉淤血的指标。在皮瓣游离于穿支血管后，对单个外侧和内侧穿支血管进行选择性夹闭和解夹，并使用微光纤分光光度计设备（O2C： Oxygen to See；LEA Medizintechnik，吉森，德国）进行了多次测量。此外，还量化了同侧和对侧腹壁浅静脉（SIEV）的静脉增压效果。
为了简单起见，我们应用了 Hartrampf（1983 年）提出的下腹部经典灌注区。无论外侧还是内侧 DIEP 穿支血管，IV 区的静脉回流最少，而 I 区的静脉引流最高。II 区和 III 区的静脉引流没有显著差异。对侧 SIEV 的增压可显著改善对侧 II 区和 IV 区的静脉回流，而同侧 SIEV 对任何区域的静脉回流均无明显改善。
本研究根据单个穿支血管和 SIEV 评估了 DIEP 皮瓣的静脉回流特点。我们的研究结果表明，无论使用哪个穿支血管，II 区和 III 区的静脉回流相似。与同侧 SIEV 相比，对侧 SIEV 的增压可导致静脉回流的改善。这可能有助于外科医生减少静脉并发症的发生，并提高 DIEP 皮瓣的存活率。
