Carrasco-López Cristian, Julian Ibañez Juan Francisco, Vilà Jordi, Luna Tomás Miguel Angel, Navinés López Jordi, Pascual Miguel Iciar, Fernandez-Llamazares-Rodriguez Jaime, Higueras-Suñe Carmen
Plastic Department, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain.
Chief of General Surgery Department, Hospital Germans Trias i Pujol, Barcelona, Spain.
Microsurgery. 2017 Sep;37(6):603-610. doi: 10.1002/micr.30171. Epub 2017 Mar 28.
Although the use of lateral intercostal artery perforator (ICAP) flaps for immediate breast reconstruction has been widely described, data on the use of the anterior ICAP (AICAP) flaps for this indication are limited. In this context, we describe the results of anatomical study and our clinical experience with AICAP flaps for breast reconstruction.
In this study, the location and characteristics of the AICAPs were dissected in 12 female adult formalin-preserved hemitrunks and two fresh-frozen cadavers. Fourteen patients (mean BMI 23) underwent partial breast resection for a quadrant breast cancer followed by breast reconstruction with an intercostal perforator flap. The mean resection size was 6 × 5 × 5.5 cm (range 3-8 × 3.5-7 × 4-8 cm).The main outcome measures were pre-operative and postradiotherapy health-related quality of life assessed with the BREAST-Q reconstruction survey.
According to anatomical study, at least one perforator was found in each third of hemitrunks dissected. The mean of perforator size was in diameter 0.42 ± 0.05 mm and in length 3.1 ± 0.36 cm. In clinical outcomes, the mean of flap size was 16 × 5 × 3 cm (range 14-19 × 3-8 × 2-5 cm). The mean surgical time was 120 min (range 109-125 min). Only one partial flap failure was detected. No postoperative changes in breast size were observed, although soft tissue changes were observed in four patients after radiotherapy. The mean BREAST-Q scores changes were 0 in satisfaction with the breast, 5 in satisfaction with outcome, 0 in psychosocial well-being, 6.15 in sexual well being, and 34.69 in physical well-being.
Based on this anatomical and clinical study, we found AICAP flap has a consistent vascularization with good perforators. And moreover, it is suitable for partial breast reconstruction (quadrantectomy) and does not appear to negatively impact patient satisfaction.
尽管外侧肋间动脉穿支（ICAP）皮瓣用于即刻乳房重建已被广泛报道，但关于前肋间动脉穿支（AICAP）皮瓣用于该适应证的数据有限。在此背景下，我们描述了AICAP皮瓣用于乳房重建的解剖学研究结果及临床经验。
在本研究中，对12具成年女性福尔马林固定的半躯干标本和2具新鲜冷冻尸体进行解剖，以确定AICAP的位置和特征。14例患者（平均体重指数23）因象限性乳腺癌接受了部分乳房切除术，随后采用肋间穿支皮瓣进行乳房重建。平均切除尺寸为6×5×5.5厘米（范围3 - 8×3.5 - 7×4 - 8厘米）。主要观察指标是通过BREAST-Q重建调查问卷评估术前和放疗后的健康相关生活质量。
根据解剖学研究，在每具半躯干标本的三分之一区域内至少发现一个穿支。穿支平均直径为0.42±0.05毫米，平均长度为3.1±0.36厘米。在临床结果方面，皮瓣平均尺寸为16×5×3厘米（范围14 - 19×3 - 8×2 - 5厘米）。平均手术时间为120分钟（范围109 - 125分钟）。仅检测到1例部分皮瓣坏死。尽管4例患者放疗后出现软组织改变，但未观察到乳房大小的术后变化。BREAST-Q评分的平均变化为：对乳房的满意度为0，对结果的满意度为5，心理幸福感为0，性幸福感为6.15，身体幸福感为34.69。
基于这项解剖学和临床研究，我们发现AICAP皮瓣血供一致，穿支良好。此外，它适用于部分乳房重建（象限切除术），且似乎不会对患者满意度产生负面影响。
