Eom Jin Sup, Kim Do Yeon, Kim Eun Key, Lee Taik Jong
Seoul, Republic of Korea From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine.
Plast Reconstr Surg. 2016 Jan;137(1):7e-13e. doi: 10.1097/PRS.0000000000001867.
A serious drawback of the deep inferior epigastric perforator (DIEP) flap is an abdominal scar that is too high. Because the umbilicus should be incorporated into the flap territory, lowering the scar is very difficult. This report describes a new DIEP flap design where the flap is placed in the lowermost part of the abdomen, well below the umbilicus, similar to a mini-abdominoplasty.
The low DIEP flap was used only for cases with moderately sized breasts and reliable perforators way below the umbilicus. The flap's lower border was on the pubic rim and the upper border was usually located 4 to 6 cm below the umbilicus. The donor defect could be closed primarily without umbilicus detachment.
From May of 2014 to October of 2014, 47 consecutive cases underwent breast reconstruction with DIEP or superficial inferior epigastric artery flaps. Of these, 27 underwent low DIEP or low superficial inferior epigastric artery flap surgery. All breast reconstructions were successful except for one case of flap failure. When compared with the conventional DIEP flap, the weight of the low DIEP flap was smaller, and venous congestion was more common in the low DIEP flap cases. The abdominal scar left by the low DIEP flap was close to the pubic rim and could be concealed by underwear.
The low DIEP flap is a new option for breast reconstruction that leaves a much more favorably located donor scar and umbilicus shape. However, planning with computed tomographic angiography is crucial to avoid venous insufficiency.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
腹壁下深动脉穿支（DIEP）皮瓣的一个严重缺点是腹部瘢痕位置过高。由于脐部应包含在皮瓣范围内，降低瘢痕位置非常困难。本报告描述了一种新的DIEP皮瓣设计，即将皮瓣置于腹部最下方，远低于脐部，类似于迷你腹壁成形术。
低位DIEP皮瓣仅用于乳房中等大小且有可靠的位于脐部下方穿支的病例。皮瓣下缘位于耻骨联合上缘，上缘通常位于脐部下方4至6厘米处。供区缺损可直接缝合而无需分离脐部。
2014年5月至2014年10月，连续47例患者接受了DIEP或腹壁下浅动脉皮瓣乳房重建术。其中，27例接受了低位DIEP或低位腹壁下浅动脉皮瓣手术。除1例皮瓣失败外，所有乳房重建均成功。与传统DIEP皮瓣相比，低位DIEP皮瓣重量更小，低位DIEP皮瓣病例中静脉淤血更常见。低位DIEP皮瓣留下的腹部瘢痕靠近耻骨联合上缘，可被内衣遮盖。
低位DIEP皮瓣是乳房重建的一种新选择，其供区瘢痕位置和脐部形态更理想。然而，通过计算机断层血管造影进行规划对于避免静脉功能不全至关重要。
临床问题/证据水平：治疗性，III级。
