Lhuaire Martin, Hivelin Mikael, Dramé Moustapha, Abrahams Peter, Kianmanesh Reza, Fontaine Christian, Lantieri Laurent
Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris V, Paris, France; Institute of Anatomy and Organogenesis, Faculté de Médecine Henri Warembourg, Université de Lille II, Lille, France; Department of General and Digestive Surgery, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Université de Reims Champagne-Ardenne, Reims, France.
Department of Plastic, Reconstructive and Aesthetic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris V, Paris, France.
J Plast Reconstr Aesthet Surg. 2017 Jun;70(6):781-791. doi: 10.1016/j.bjps.2017.01.008. Epub 2017 Feb 13.
The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate. This anatomical observational study aimed to determine whether anatomy could address this dilemma by determining the best vessel diameter to match the donor with these three recipient sites.
Our series reports 80 dissections of the three anatomical regions of interest. Forty formalin-preserved female cadavers were dissected bilaterally. Internal vessels diameter measurements were recorded with a vascular gauge ranging from 1.0 to 5.0 mm with successive half-millimeter graduations.
The median diameter of the deep inferior epigastric (DIEA), internal thoracic (ITA), circumflex scapular (CSA), and thoracodorsal arteries (TDA) were: 2.0, 2.5, 2.5, and 1.5 mm, respectively. The median diameter of the deep inferior epigastric, internal thoracic, circumflex scapular, and thoracodorsal veins were: 3.0, 3.0, 3.0, and 2.5 mm, respectively. At the individual level, the perfect match between DIEA and ITA was significantly more frequent than between DIEA and TDA (p = 0.002), and it was more frequent between DIEA and CSA than between DIEA and TDA (p = 0.009).
This study supports the use of the internal thoracic pedicle as the first recipient vessel choice, which should be considered, at least anatomically, as the best one with the closest diameter matching with the donor pedicle.
腹壁下深动脉穿支（DIEP）皮瓣是一种用于自体显微外科乳房重建的可靠且可重复的技术。已描述了多个用于微血管吻合的受区血管部位，如胸廓内血管、胸背血管和旋肩胛血管。尽管如此，受区部位的选择主要取决于术者个人的经验和偏好，目前最佳的受区血管部位仍存在争议。这项解剖学观察研究旨在通过确定与这三个受区部位相匹配的最佳血管直径，来判定解剖学能否解决这一难题。
我们的系列研究报告了对三个感兴趣解剖区域的80次解剖。对40具用福尔马林保存的女性尸体进行双侧解剖。使用刻度为0.5毫米、范围从1.0至5.0毫米的血管测量仪记录血管内径。
腹壁下深动脉（DIEA）、胸廓内动脉（ITA）、旋肩胛动脉（CSA）和胸背动脉（TDA）的中位直径分别为：2.0毫米、2.5毫米、2.5毫米和1.5毫米。腹壁下深静脉、胸廓内静脉、旋肩胛静脉和胸背静脉的中位直径分别为：3.0毫米、3.0毫米、3.0毫米和2.5毫米。在个体层面，DIEA与ITA之间完美匹配的频率显著高于DIEA与TDA之间（p = 0.002），且DIEA与CSA之间完美匹配的频率高于DIEA与TDA之间（p = 0.009）。
本研究支持将胸廓内蒂作为首选的受区血管，至少从解剖学角度来看，它应被视为与供体蒂直径最接近匹配的最佳选择。
