Section of Plastic and Reconstructive Surgery, Department of General Surgery, General Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria; maz - Microsurgical Training and Research Center, Industriezeile 36/7, 4020 Linz, Austria.
Center for Anatomy and Cell Biology, Medical University of Vienna, Waehringer Strasse 13, 1090 Vienna, Austria.
J Plast Reconstr Aesthet Surg. 2014 Jan;67(1):42-7. doi: 10.1016/j.bjps.2013.08.017. Epub 2013 Sep 3.
Pedicled perforator flaps in the trunk such as the DIEAP or the IMAP-flap have increasingly been used for reconstructive purposes. However, perforator flaps of the upper abdominal wall derived from the SEA and DIEA have not been widely reported in literature. The aim of this study was to investigate the vascular basis of perforator flaps of the upper abdominal wall based on the epigastric vascular axis and to describe the location and size of the individual flaps.
The superior and deep inferior epigastric artery perforators (SEAPs and DIEAPs) of the supraumbilical abdominal wall of ten fresh anatomical specimens were selectively injected with Methylene blue solution or India ink. The location and size of the labeled skin area was observed. Finally, the arterial perforators were dissected and the length, diameter and the distance of the perforation point to the midline, xiphoid process and umbilicus were recorded.
The SEAPs and DIEAPs supplied the ventromedial skin of the lower thoracic and supraumbilical abdominal wall in a sequential order. The mean size of all injected skin areas was 65 ± 31.4 cm(2) (10.2 × 8.8 cm). A mean number of 9.7 ± 4.2 perforators per specimen was identified. The mean external diameter of the dissected perforators was 0.82 ± 0.32 mm. The perforator length until arborization averaged 3.44 ± 1.07 cm. Most perforators were located in an area 2-6 cm from the midline and 0-10 cm below the xiphoid process.
Through selective injection of perforators, a reliable anatomy of SEAP- and DIEAP-flaps of the upper abdominal wall could be demonstrated. From a clinical point of view, subcostal SEAP-flaps are of special interest. These flaps may be rotated cranially for lower chest wall or breast reconstruction or deflected caudally for abdominal wall reconstructive purposes. The harvest site can be closed directly or via a reverse abdominoplasty procedure.
躯干部位的带蒂穿支皮瓣，如 DIEAP 或 IMAP 皮瓣，已越来越多地被用于重建目的。然而，源自 SEA 和 DIEA 的上腹部壁穿支皮瓣在文献中尚未广泛报道。本研究旨在基于上腹血管轴研究上腹部壁穿支皮瓣的血管基础，并描述各个皮瓣的位置和大小。
选择性地向十个新鲜解剖标本的上腹部脐上区域的腹壁上、深部下脐动脉穿支（SEAP 和 DIEAP）注入亚甲蓝溶液或印度墨汁。观察标记皮肤区域的位置和大小。最后，解剖动脉穿支，并记录穿支点到中线、剑突和脐的长度、直径和距离。
SEAP 和 DIEAP 依次供应下胸壁和上腹部脐上区域的腹侧内侧皮肤。所有注射皮肤区域的平均大小为 65 ± 31.4cm²（10.2×8.8cm）。每个标本平均识别出 9.7 ± 4.2 个穿支。解剖穿支的平均外径为 0.82 ± 0.32mm。穿支的分支前长度平均为 3.44 ± 1.07cm。大多数穿支位于距中线 2-6cm 和剑突下 0-10cm 的区域。
通过选择性注射穿支，可以证明上腹部壁 SEAP 和 DIEAP 皮瓣具有可靠的解剖结构。从临床角度来看，肋缘下 SEAP 皮瓣特别有趣。这些皮瓣可以向头侧旋转用于下胸壁或乳房重建，或者向尾侧偏转用于腹壁重建。可以直接或通过反向腹部整形术关闭供区。
