Leung Rachael, Chae Michael P, Tobin Vicky, Hunter-Smith David J, Rozen Warren M
Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia.
Peninsula Clinical School, Central Clinical School at Monash University, Melbourne, Victoria, Australia.
Plast Reconstr Surg Glob Open. 2018 Oct 4;6(10):e1960. doi: 10.1097/GOX.0000000000001960. eCollection 2018 Oct.
There is limited understanding of anatomy of perforator angiosomes, or "perforasomes," of the deep inferior epigastric artery (DIEA). A perforasome is defined as the territory perfused by a single perforator vessel of a named artery, such as the DIEA. Given the clinical significance of this anatomical concept in microsurgical breast reconstruction, this study is a quantitative investigation of DIEA perforasome characteristics and patterns associated with perforasome size, perforator caliber, location and branching, using computed tomographic (CT) angiography.
Twenty abdominal arterial-phase CT angiograms were analyzed in 3 dimensions using software (Horos). DIEA perforasomes were mapped, yielding data on 40 medial-row and 40 lateral-row perforasomes. Perforator branch extents and number were measured using 3-dimensional multi-planar reconstruction, and perforator caliber on axial slices.
Perforasomes exhibited eccentric branching distributions in horizontal and vertical axes, that is, a majority of perforators were not centrally located within their perforasomes. Lateral-row perforasomes displayed greater horizontal eccentricity than medial-row. There was a positive correlation between perforator caliber and perforasome size. Medial-row perforators had more branches and larger caliber than lateral-row.
This is the first article to quantify relationships between perforators and their territories of supply in vivo, augmenting current understanding of perforasome theory. DIEA perforasomes can be readily visualized and mapped with CT angiography, which may enable effective preoperative flap planning in DIEA perforator flap breast reconstruction. Future investigation may highlight the importance of this information in improving surgical outcomes, including flap survival and fat necrosis reduction, through careful, perforasome-based flap design.
对于腹壁下动脉（DIEA）穿支血管体（即“穿支体”）的解剖结构了解有限。穿支体被定义为由特定动脉（如DIEA）的单个穿支血管灌注的区域。鉴于这一解剖学概念在显微外科乳房重建中的临床意义，本研究使用计算机断层扫描（CT）血管造影术对DIEA穿支体特征以及与穿支体大小、穿支口径、位置和分支相关的模式进行了定量研究。
使用软件（Horos）对20例腹部动脉期CT血管造影进行三维分析。绘制DIEA穿支体图谱，得出40个内侧排和40个外侧排穿支体的数据。使用三维多平面重建测量穿支分支范围和数量，并在轴位切片上测量穿支口径。
穿支体在水平和垂直轴上呈现偏心分支分布，即大多数穿支并不位于其穿支体的中心位置。外侧排穿支体的水平偏心度大于内侧排。穿支口径与穿支体大小呈正相关。内侧排穿支比外侧排有更多分支且口径更大。
本文首次对体内穿支与其供血区域之间的关系进行了量化，加深了对穿支体理论的当前理解。DIEA穿支体可通过CT血管造影轻松可视化和绘制图谱，这可能有助于在DIEA穿支皮瓣乳房重建中进行有效的术前皮瓣规划。未来的研究可能会突出这一信息在通过基于穿支体的精细皮瓣设计改善手术效果（包括皮瓣存活和减少脂肪坏死）方面的重要性。
