Kim Deok-Yeol, Lee Taik Jong, Kim Eun Key, Yun Jiyoung, Eom Jin Sup
Department of Plastic and Reconstructive Surgery, Korea University Guro Hospital;
Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Plast Surg (Oakv). 2015 Winter;23(4):255-9.
Even with patent deep inferior epigastric vein anastomoses, venous congestion can occur during free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric artery perforator (DIEP) flap surgery and lead to flap compromise if not recognized and managed.
To identify the incidence of intraoperative venous congestion and describe the best available prevention and treatment methods.
Systematic electronic searches of the PubMed database including Medline were performed to identify studies published until 2014. The following keywords were used: "DIEP" or "free TRAM" and "venous insufficiency" or "venous congestion". Supplemental searches were conducted to identify referenced studies. Statistical analysis using the χ(2) test was performed.
Nine studies representing 4747 free abdominal flaps cases were included and demonstrated an overall incidence of intraoperative venous congestion of 2.8%. The incidence in DIEP flaps (3.3%) was significantly higher than that in the free TRAM flaps (1.0%). All nine articles reported using the superficial inferior epigastric vein to treat venous insufficiency.
The risk for developing intraoperative venous congestion following free abdominal flap breast reconstruction is influenced by inadequate perforator selection and persistent dominance in the superficial venous system. The solution is establishing another venous draining route using the superficial inferior epigastric vein.
即使腹壁下深静脉吻合通畅，在游离腹直肌肌皮瓣（TRAM）或腹壁下深动脉穿支皮瓣（DIEP）手术过程中仍可能发生静脉淤血，如果未被识别和处理，会导致皮瓣受损。
确定术中静脉淤血的发生率，并描述现有的最佳预防和治疗方法。
对包括Medline在内的PubMed数据库进行系统电子检索，以识别截至2014年发表的研究。使用了以下关键词：“DIEP”或“游离TRAM”以及“静脉功能不全”或“静脉淤血”。进行补充检索以识别参考文献研究。采用χ(2)检验进行统计分析。
纳入了9项研究，共4747例游离腹部皮瓣病例，术中静脉淤血的总体发生率为2.8%。DIEP皮瓣的发生率（3.3%）显著高于游离TRAM皮瓣（1.0%）。所有9篇文章均报道使用腹壁下浅静脉治疗静脉功能不全。
游离腹部皮瓣乳房重建术后发生术中静脉淤血的风险受穿支选择不当和浅静脉系统持续优势的影响。解决方法是利用腹壁下浅静脉建立另一条静脉引流途径。
