Cho Min-Jeong, Haddock Nicholas T, Gassman Andrew A, Teotia Sumeet S
Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Division of Plastic and Reconstructive Surgery, Temple University.
Plast Reconstr Surg. 2018 Oct;142(4):867-870. doi: 10.1097/PRS.0000000000004730.
The success of microvascular reconstruction depends on many factors. Although many factors cannot be dictated by a surgeon, the success of anastomosis can be maximized by honing skill with performing anastomoses. However, size discrepancy of vessels remains a common challenge, given the lack of an ideal technique. In this study, the authors introduce their experience in using composite deep inferior epigastric arterial and venous grafts to overcome the vessel size and pedicle length discrepancy in lateral thigh and superficial inferior epigastric artery (SIEA) flaps. Of the 1095 flaps performed, the authors identified a total of 12 flaps (one lateral thigh flap and 11 SIEA flaps) on nine patients for breast reconstruction. The authors used deep inferior epigastric vessels to act as interposition grafts between the internal mammary artery and flap pedicle. For the SIEA flaps, the authors anastomosed the SIEA system to the deep inferior epigastric arterial system, checked the viability of the flap, and then transferred the flap to the internal mammary artery and flap pedicle. For the SIEA flaps, the authors anastomosed the SIEA system to the deep inferior epigastric arterial system, checked the viability of the flap, and then transferred the flap to the internal mammary artery system in three patients. In the last five patients, the authors anastomosed the deep inferior epigastric vessels to the internal mammary artery system first, and then transferred the SIEA flap. For the lateral thigh flap, the authors anastomosed grafts to the internal mammary artery system first as well. There were no flap losses or fat necrosis. Although the authors' outcomes are limited to only breast reconstruction, they believe this method could be expanded to different types of reconstruction, especially reconstruction of the head and neck.
微血管重建的成功取决于多种因素。尽管许多因素并非外科医生所能掌控，但通过磨练吻合技术可使吻合成功率最大化。然而，鉴于缺乏理想技术，血管大小差异仍是一个常见挑战。在本研究中，作者介绍了他们使用腹壁下深动脉和静脉复合移植物来克服大腿外侧皮瓣和腹壁浅动脉（SIEA）皮瓣血管大小及蒂长度差异的经验。在1095例实施的皮瓣手术中，作者在9例患者身上共识别出12例皮瓣（1例大腿外侧皮瓣和11例SIEA皮瓣）用于乳房重建。作者使用腹壁下深血管作为胸廓内动脉与皮瓣蒂之间的间置移植物。对于SIEA皮瓣，作者将SIEA系统与腹壁下深动脉系统进行吻合，检查皮瓣的活力，然后将皮瓣转移至胸廓内动脉和皮瓣蒂。对于SIEA皮瓣，在3例患者中，作者将SIEA系统与腹壁下深动脉系统进行吻合，检查皮瓣的活力，然后将皮瓣转移至胸廓内动脉系统。在最后5例患者中，作者先将腹壁下深血管与胸廓内动脉系统进行吻合，然后转移SIEA皮瓣。对于大腿外侧皮瓣，作者同样先将移植物与胸廓内动脉系统进行吻合。未出现皮瓣丢失或脂肪坏死情况。尽管作者的结果仅限于乳房重建，但他们认为这种方法可扩展至不同类型的重建，尤其是头颈部重建。
