Bank Jonathan, Pavone Lucio A, Seitz Iris A, Roughton Michelle C, Schechter Loren S
Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL.
Eplasty. 2012;12:e52. Epub 2012 Dec 3.
The report herein presents a case of a 49-year-old woman with left breast cancer who presented seeking immediate autologous reconstruction. Surgical history included an abdominal hysterectomy and an abdominal contouring procedure. This is a first description of a deep inferior epigastric perforator flap after abdominal wall manipulation of this magnitude.
Computed tomographic angiography identified patent medial row perforators. Doppler confirmed the location of the perforators. The flap was designed with the inferior incision at the previous lower abdominal scar. Laser-assisted indocyanine green imaging confirmed adequate flap perfusion on the basis of a single left deep inferior epigastric perforator.
The flap was harvested on one perforator and anastomosed to the internal mammary system. The postoperative course was complicated by venous anastomosis kinking, requiring revision, but otherwise unremarkable.
Computed tomographic angiography confirmed presence of perforators, communication with the deep inferior epigastric system, and location acceptable for flap design. Laser-assisted indocyanine green angiography facilitated perforator selection and provided intraoperative assessment of flap perfusion. Utilization of these modalities allowed safe completion of an operation considered contraindicated by conventional algorithms and highlights their role in complex perforator flap reconstruction.
本文报告一例49岁左乳腺癌女性患者，该患者前来寻求即刻自体乳房重建。手术史包括腹部子宫切除术和腹部塑形手术。这是首次对腹壁进行如此大规模手术操作后采用腹壁下深动脉穿支皮瓣的描述。
计算机断层血管造影术确定内侧排穿支血管通畅。多普勒超声确定穿支血管的位置。皮瓣以下腹部既往瘢痕处作为下切口进行设计。基于单根左侧腹壁下深动脉穿支，激光辅助吲哚菁绿成像证实皮瓣灌注充足。
皮瓣基于一根穿支血管切取，并与胸廓内血管系统吻合。术后病程因静脉吻合口扭结而复杂化，需要进行修复，但除此之外并无异常。
计算机断层血管造影术证实穿支血管的存在、与腹壁下深血管系统的连通性以及皮瓣设计可接受的位置。激光辅助吲哚菁绿血管造影术有助于穿支血管的选择，并提供术中皮瓣灌注评估。这些方法的应用使得被传统算法视为禁忌的手术得以安全完成，并突出了它们在复杂穿支皮瓣重建中的作用。
