Ingvaldsen Christoffer Aam, Tønseth Kim Alexander, Pripp Are Hugo, Tindholdt Tyge Tind
Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway; Institute for Surgical Research, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; and Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
Plast Reconstr Surg Glob Open. 2016 Feb 10;4(2):e616. doi: 10.1097/GOX.0000000000000602. eCollection 2016 Feb.
No studies have assessed the perfusion of the undermined abdominal skin in breast reconstruction with deep inferior epigastric artery perforator flap. A greater understanding of the procedure's impact on the perfusion of the abdominal skin can be valuable in predicting areas susceptible to necrosis.
Microcirculatory changes were monitored in the abdominal skin of 20 consecutive patients undergoing breast reconstruction with a deep inferior epigastric artery perforator flap. Quantitative mapping was performed with laser Doppler perfusion imaging at 7 set intervals. Measurements were taken and recorded within 4 standardized zones covering the skin between the xiphoid process and the upper incisional boundary of the flap (zones 1-4; cranial to caudal).
Before commencing surgery, a significantly higher perfusion was registered in zones 3 and 4 when compared with zone 1. After undermining the abdominal skin, the perfusion in zones 1-3 increased significantly. After the abdominal closure, the perfusion dropped in all 4 zones and only the perfusion level in zone 1 remained significantly higher than preoperative mean. Postoperatively, the perfusion of each zone stabilized at a significantly higher level compared with preoperative values. No tissue necrosis was observed in any of the zones.
Although perforators are divided during undermining of the abdominal skin, there seems to be a reactive hyperemia that exceeds the blood supply delivered by the perforators. Thus, due to microcirculatory mechanisms, the undermining of the abdomen during the procedure does not seem to present any great risk of tissue necrosis.
尚无研究评估腹壁下动脉穿支皮瓣乳房重建术中腹部潜行剥离皮肤的灌注情况。更深入了解该手术对腹部皮肤灌注的影响，对于预测易发生坏死的区域可能具有重要价值。
对连续20例行腹壁下动脉穿支皮瓣乳房重建术的患者腹部皮肤的微循环变化进行监测。使用激光多普勒灌注成像以7个设定间隔进行定量映射。在覆盖剑突与皮瓣上切口边界之间皮肤的4个标准化区域（区域1 - 4；从颅侧到尾侧）内进行测量并记录。
手术开始前，区域3和区域4的灌注明显高于区域1。腹部皮肤潜行剥离后，区域1 - 3的灌注显著增加。腹部关闭后，所有4个区域的灌注均下降，只有区域1的灌注水平仍显著高于术前平均值。术后，每个区域的灌注稳定在明显高于术前值的水平。所有区域均未观察到组织坏死。
虽然在腹部皮肤潜行剥离过程中穿支被切断，但似乎存在一种反应性充血，其超过了穿支提供的血液供应。因此，由于微循环机制，手术过程中腹部的潜行剥离似乎不会带来任何严重的组织坏死风险。
