Sowa Yoshihiro, Yokota Isao, Fujikawa Kei, Morita Daiki, Taguchi Tetsuya, Numajiri Toshiaki
a Department of Plastic and Reconstructive Surgery , Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine , Kyoto , Japan.
b Department of Biostatistics , Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine , Kyoto , Japan.
J Plast Surg Hand Surg. 2019 Jun;53(3):125-129. doi: 10.1080/2000656X.2018.1533839. Epub 2019 Feb 8.
Problems in breast reconstruction with deep inferior epigastric perforator (DIEP) flaps include postoperative fat induration and necrosis. A resulting clinical symptom is palpable indurated tissue, but it is difficult to measure the stiffness of transplanted fat tissues objectively at a deep site. The ability to perform shear-wave elastography (SWE) was recently added to some common ultrasonic echo devices, enabling objective three-dimensional measurements of tissue stiffness. In this study, we measured the stiffness of transplanted DIEP flaps using SWE to examine the effects of measurement sites, flap size and perforator patterns on stiffness. The subjects were 26 patients who showed induration of a transplanted flap on palpation in follow-up observation performed more than 6 months after breast reconstruction with a DIEP flap. The effects of the weight of the transplanted flap, and the diameter, number and location of the perforators on the stiffness of fat tissue were also analyzed. Within each zone, distal regions showed higher values, but in Zone II, significantly higher stiffness was also found in the proximal region. Multivariate regression analysis including all measurement sites, the weight of transplanted flap, and diameter, number and location of perforators showed that the stiffness of fat tissue was significantly higher in subjects with a larger weight flap. For safe reconstruction, it will be useful to examine the stiffness of fat tissue in individual regions of a transplanted flap retrospectively, because the examination results can be used in actual clinical practice.
采用腹壁下深动脉穿支（DIEP）皮瓣进行乳房重建存在的问题包括术后脂肪硬结和坏死。由此产生的临床症状是可触及的硬结组织，但在深部位置客观测量移植脂肪组织的硬度却很困难。最近，一些常见的超声回声设备增加了剪切波弹性成像（SWE）功能，能够对组织硬度进行客观的三维测量。在本研究中，我们使用SWE测量移植的DIEP皮瓣的硬度，以研究测量部位、皮瓣大小和穿支模式对硬度的影响。研究对象为26例患者，这些患者在采用DIEP皮瓣进行乳房重建6个月以上的随访观察中，触诊发现移植皮瓣有硬结。我们还分析了移植皮瓣的重量、穿支的直径、数量和位置对脂肪组织硬度的影响。在每个区域内，远端区域的值较高，但在区域II中，近端区域也发现了明显更高的硬度。包括所有测量部位、移植皮瓣的重量以及穿支的直径、数量和位置的多变量回归分析表明，皮瓣重量较大的受试者脂肪组织的硬度明显更高。为了安全地进行重建，回顾性检查移植皮瓣各个区域的脂肪组织硬度将是有用的，因为检查结果可用于实际临床实践。
