Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
J Plast Reconstr Aesthet Surg. 2014 Feb;67(2):212-8. doi: 10.1016/j.bjps.2013.10.048. Epub 2013 Nov 8.
DIEP flaps are a popular choice for autologous breast reconstruction, though many surgeons routinely discard zone IV, limiting transferrable tissue. We investigated the effect of altering number and location of perforators supplying the flap on total pedicle flow and perfusion of skin and fat of zone IV.
20 cranially-based abdominal epigastric perforator flaps were raised in rats on two perforators. The perforators were sequentially clamped and released in a randomised order and total pedicle flow measured using microvascular flow-probes, on the following perforator combinations: 13 DIEP flaps were raised in post-mastectomy patients requiring breast reconstruction on two perforators. These were clamped and released as before to assess perfusion of fat and skin in zone IV using SPY indocyanine-green-fluorescence-angiography scans on the same perforator combinations as in our animal study, listed above.
All data were analysed using 2-way-ANOVA and revealed that vascular flow was significantly (p < 0.0001) greater on one perforator as opposed to two. These results were supported by our human study, revealing both zone IV fat and skin perfusion were significantly (p < 0.0001) greater when a single perforator was used.
Our data suggests total pedicle flow and perfusion of zone IV fat and skin is significantly higher on a single perforating blood vessel as opposed to two. Reasons for these observed differences could be due to changing pressure gradients across a piece of tissue prone to venous congestion, with maintenance of flow better in a single lumen.
DIEP 皮瓣是自体乳房重建的常用选择，但许多外科医生常规丢弃 IV 区，限制了可转移的组织。我们研究了改变供应皮瓣的穿支血管数量和位置对总蒂血流以及 IV 区皮肤和脂肪灌注的影响。
在大鼠身上，我们基于两个穿支血管抬高了 20 个颅侧腹部上腹皮穿支皮瓣。随机顺序夹闭和释放穿支血管，并使用微血管血流探头测量总蒂血流，在以下穿支血管组合中进行：在需要乳房重建的乳房切除术后患者中抬高了 13 个 DIEP 皮瓣基于两个穿支血管。按照与我们的动物研究相同的穿支血管组合（如上所述），以相同的顺序夹闭和释放这些穿支血管，以评估 IV 区的脂肪和皮肤灌注情况，使用 SPY 吲哚菁绿荧光血管造影扫描。
所有数据均使用双因素方差分析进行分析，结果表明，与两个穿支血管相比，一个穿支血管的血管流量明显更大（p<0.0001）。我们的人体研究结果也支持了这一结果，表明当使用单个穿支血管时，IV 区脂肪和皮肤的灌注明显更高（p<0.0001）。
我们的数据表明，与两个穿支血管相比，单个穿支血管的总蒂血流和 IV 区脂肪和皮肤的灌注明显更高。这些观察到的差异的原因可能是由于组织内静脉淤血导致的压力梯度变化，而在单个管腔中，血流的维持更好。
