Johnson Anna Rose, Bravo Miguel G, Granoff Melisa D, Kang Christine O, Critchlow Jonathan F, Tsai Leo L, Lee Bernard T, Singhal Dhruv
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Plast Reconstr Surg Glob Open. 2019 Sep 30;7(9):e2436. doi: 10.1097/GOX.0000000000002436. eCollection 2019 Sep.
The vascularized omental free flap has been described as a reliable option for the treatment of peripheral lymphedema. However, the flap has been associated with venous hypertension which may require venous supercharging or intra-flap arteriovenous fistula creation to offload the arterial inflow. The aim of this study is to introduce and present our experience using a flow-through omental flap as a novel approach to optimize flap hemodynamics. A retrospective review of a prospectively maintained quality improvement database was performed. Seven consecutive patients with unilateral breast cancer-related lymphedema (BCRL) who underwent delayed lymphatic reconstruction using a flow-through omental free flap were identified. In all patients, the right gastroepiploic artery and vein were anastomosed to the proximal end of the radial artery and to one venae comitante, respectively. An anastomosis of the distal end of the radial artery to the left gastroepiploic artery was performed. The flap was then supercharged by anastomosing the left gastroepiploic vein to the cephalic or basilic vein. There were no flap losses or other surgical complications. A distinct advantage of this inset includes the ability to moderate the arterial in-flow to the omental flap to avoid an inflow-outflow mismatch and alleviate venous hypertension. Further study is needed to validate this technique in a larger study sample with longer follow-up.
带血管蒂网膜游离皮瓣已被描述为治疗周围性淋巴水肿的可靠选择。然而，该皮瓣与静脉高压有关，这可能需要静脉增压或在皮瓣内创建动静脉瘘以减轻动脉血流负担。本研究的目的是介绍并展示我们使用流通式网膜皮瓣作为优化皮瓣血流动力学的新方法的经验。对前瞻性维护的质量改进数据库进行了回顾性分析。确定了7例连续的单侧乳腺癌相关淋巴水肿（BCRL）患者，他们接受了使用流通式网膜游离皮瓣的延迟淋巴重建术。在所有患者中，分别将右胃网膜动脉和静脉与桡动脉近端和一条伴行静脉吻合。将桡动脉远端与左胃网膜动脉进行吻合。然后通过将左胃网膜静脉与头静脉或贵要静脉吻合来对皮瓣进行增压。没有皮瓣丢失或其他手术并发症。这种植入方式的一个明显优点是能够调节进入网膜皮瓣的动脉血流，以避免流入-流出不匹配并减轻静脉高压。需要进一步研究以在更大的研究样本中进行更长时间的随访来验证该技术。
