Vollbach Felix H, Heitmann Christoph D, Fansa Hisham
Center for Aesthetic Plastic Surgery and Reconstructive Breast Surgery, Prof. Heitmann & Prof. Fansa, Munich, Germany.
Plast Reconstr Surg Glob Open. 2016 Dec 13;4(12):e1144. doi: 10.1097/GOX.0000000000001144. eCollection 2016 Dec.
The usage of internal mammary artery perforators (IMAPs) has been described in autologous breast reconstruction although IMAPS are not yet considered standard recipient vessels. It remains unclear if these vessels can be safely used in large flaps after radiation therapy or in delayed breast reconstruction.
Over a 2-year period, 515 free flaps for autologous breast reconstruction were performed on 419 patients by 2 surgeons (S1 and S2). In a retrospective analysis, time of reconstruction, ischemia time, flap weight, diameter of couplers, and complications were analyzed. All 515 flaps were compared in a subset with regard to the 2 surgeons: S1 who always used the IMA as a recipient vessel and S2 who attempted IMAP use if possible.
Of all 515 flaps, 424 were abdominal flaps and 91 flaps were from the upper thigh. Three hundred six cases were immediate reconstructions, and 112 were delayed reconstructions. In 97 cases, implants were converted to autologous tissue. In 112 cases, the IMAPs were used; of these, 82 were immediate and 17 were delayed reconstructions, and in 13 cases, implants were removed. Thirty-five percent of all anastomoses to IMAPs had previous radiation therapy. The flap failure rate was 1.9%. In none of these cases, the IMAPs were used. S1 never used the IMAP, and S2 used the IMAP in 37% of all of his flaps.
IMAPs were safely used in all kinds of reconstructions and after radiation therapy, with no flap failure or negative effects on mastectomy skin flap perfusion. Using the IMAPs as recipient vessels is a further step toward simplifying microsurgical breast reconstruction.
尽管乳内动脉穿支（IMAPs）尚未被视为标准的受区血管，但在自体乳房重建中已有其应用的相关描述。目前尚不清楚这些血管能否安全地用于放疗后的大型皮瓣或延迟性乳房重建。
在两年时间里，两位外科医生（S1和S2）为419例患者进行了515例自体乳房重建的游离皮瓣手术。通过回顾性分析，对重建时间、缺血时间、皮瓣重量、吻合器直径和并发症进行了分析。在一个亚组中，对所有515例皮瓣就两位外科医生进行了比较：S1总是使用胸廓内动脉作为受区血管，S2则尽可能尝试使用IMAPs。
在所有515例皮瓣中，424例为腹部皮瓣，91例来自大腿上部。306例为即刻重建，112例为延迟重建。97例中，植入物被转换为自体组织。112例中使用了IMAPs；其中，82例为即刻重建，17例为延迟重建，13例中移除了植入物。所有与IMAPs吻合的病例中有35%曾接受过放疗。皮瓣失败率为1.9%。在这些病例中，均未使用IMAPs。S1从未使用过IMAP，S2在其所有皮瓣中有37%使用了IMAP。
IMAPs在各种重建手术及放疗后均能安全使用，未出现皮瓣失败或对乳房切除皮瓣灌注产生负面影响。将IMAPs用作受区血管是朝着简化显微外科乳房重建迈出的又一步。
