Pons Gemma, Masia Jaume, Sanchez-Porro Lídia, Larrañaga Jose, Clavero Juan Angel
From the *Department of Plastic and Reconstructive Surgery, Hospital de la Santa, Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona; and †Radiology Department, Clinica Creu Blanca, Barcelona, Spain.
Ann Plast Surg. 2014 Dec;73(6):659-61. doi: 10.1097/SAP.0b013e318285873e.
One of the main steps in perforator flap surgery is to identify the dominant perforator. Using multidetector row computed tomography (MDCT) for the preoperative planning of deep inferior epigastric artery perforator (DIEAP) flap surgery, we identified a perforator with a large caliber, an excellent location in the middle abdominal region, and a totally extramuscular trajectory in a significant number of patients. We describe the frequency of this perforator and determine its characteristics.
We conducted a retrospective study of 482 patients who underwent 526 DIEAP flaps for breast reconstruction from October 2003 to October 2011. Mean age at surgery was 51.3 years old. A preoperative MDCT of abdominal vascularization was performed in all patients.
MDCT identified a dominant perforator with a paramuscular course in 12.4% of abdominal walls. In all cases, it was located in the midline and emerged directly from the deep inferior epigastric system. Its mean caliber was 1.9 mm. The flap was harvested based on this perforator in all these patients, and mean harvest time was 51 minutes. The characteristics of this perforator made dissection easier and reduced morbidity at the donor site. There were no flap losses and the only complications were minor.
We located a paramuscular perforator in 12.4% of patients undergoing breast reconstruction with abdominal perforator flaps. Its morphological features and extramuscular course make it the perforator of choice in DIEAP flap surgery.
穿支皮瓣手术的主要步骤之一是识别优势穿支。在使用多排螺旋计算机断层扫描（MDCT）进行腹壁下动脉穿支（DIEAP）皮瓣手术的术前规划时，我们在大量患者中发现了一支口径大、位于腹部中部位置极佳且走行完全位于肌肉外的穿支。我们描述了这支穿支的出现频率并确定了其特征。
我们对2003年10月至2011年10月期间接受526例DIEAP皮瓣进行乳房重建的482例患者进行了回顾性研究。手术时的平均年龄为51.3岁。所有患者均进行了腹部血管成像的术前MDCT检查。
MDCT在12.4%的腹壁中发现了一支走行于肌肉旁的优势穿支。在所有病例中，它都位于中线，直接发自腹壁下动脉系统。其平均口径为1.9毫米。所有这些患者均基于这支穿支切取皮瓣，平均切取时间为51分钟。这支穿支的特征使解剖更容易，并降低了供区的发病率。没有皮瓣丢失，仅出现了轻微并发症。
在接受腹部穿支皮瓣乳房重建的患者中，我们在12.4%的患者中发现了一支肌肉旁穿支。其形态特征和肌肉外走行使其成为DIEAP皮瓣手术中的首选穿支。
