Elzawawy Ehab M, Kelada Melad N, Al Karmouty Ahmed F
Anatomy and Embryology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt.
Anat Res Int. 2016;2016:7696010. doi: 10.1155/2016/7696010. Epub 2016 Sep 29.
. Submammary adipofascial flap (SMAF) is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length. . The flap was designed and dissected on both sides in 10 female cadavers. SMAF outline was 10 cm in length and 7 cm in width. The flap was raised carefully from below upwards to identify the perforator vessels supplying it from all directions. These vessels were counted and the following measurements were taken using Vernier caliper: diameter, total length, length inside the flap, and distance below the submammary skin crease. . The perforators at the lateral part of the flap took origin from the lateral thoracic, thoracodorsal, and intercostal vessels. They were significantly larger, longer, and of multiple origins than those on the medial part of the flap and this suggests that laterally based flaps will have better blood supply, better viability, and more promising prognosis. Both approaches, medially based and laterally based SMAF, carry a better prognosis and lesser chance for future fat necrosis than the classical cranially based flap.
乳房下脂肪筋膜瓣（SMAF）是乳房下部替代的一种有价值的选择。它对于部分乳房切除术缺损的重建特别有用。它也用于覆盖乳房植入物。大多数外科医生将此皮瓣的基底部置于乳房下皮肤皱襞的头侧，将其翻转至乳房上。供应该皮瓣的血管不明确，由于其血管供应不确定，皮瓣的切取可能会受到影响。这项工作的目的是识别供应SMAF的穿支血管，并确定其起源、位置、直径和长度。在10具女性尸体上双侧设计并解剖该皮瓣。SMAF的轮廓长10厘米，宽7厘米。从下向上小心掀起皮瓣，以识别从各个方向供应它的穿支血管。对这些血管进行计数，并使用游标卡尺进行以下测量：直径、总长度、皮瓣内长度以及乳房下皮肤皱襞下方的距离。皮瓣外侧部分的穿支血管起源于胸外侧、胸背和肋间血管。它们比皮瓣内侧部分的穿支血管明显更大、更长且起源多样，这表明以外侧为蒂的皮瓣将有更好的血液供应、更好的活力和更有希望的预后。与传统的以头侧为蒂的皮瓣相比，以内侧为蒂和以外侧为蒂的SMAF这两种方法都有更好的预后，未来脂肪坏死的可能性更小。
