Helm Douglas L, Steigner Michael L, Serebrakian Arman T, Erdmann-Sager Jessica
Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Plast Reconstr Surg Glob Open. 2020 Jul 24;8(7):e2934. doi: 10.1097/GOX.0000000000002934. eCollection 2020 Jul.
We present 2 patients in whom the course of the deep inferior epigastric vessels was intra-abdominal during deep inferior epigastric perforator (DIEP) flap breast reconstruction. Preoperative computed tomography angiography gave no indication of an unusual pedicle location. In both cases, pedicle dissection was completed safely without bowel injury, and reconstruction was completed successfully. Reconstructive surgeons need not abandon DIEP flap reconstruction upon discovering that the deep inferior epigastric vessels are intra-abdominal. Unfortunately, computed tomography angiography imaging does not identify this variant preoperatively. The risk of postoperative ileus after intra-abdominal pedicle dissection may be higher than the risk after dissection of retrorectus deep inferior epigastric pedicles, and thus it is reasonable to consider the use of prophylactic mesh in these cases.
我们报告了2例在腹壁下动脉穿支（DIEP）皮瓣乳房重建术中腹壁下血管走行于腹腔内的患者。术前计算机断层血管造影未提示蒂部位置异常。在这两例中，蒂部分离均安全完成，未损伤肠道，重建也成功完成。重建外科医生在发现腹壁下血管走行于腹腔内时无需放弃DIEP皮瓣重建。不幸的是，计算机断层血管造影成像在术前无法识别这种变异。腹腔内蒂部分离术后肠梗阻的风险可能高于腹直肌后腹壁下蒂部分离术后的风险，因此在这些病例中考虑使用预防性补片是合理的。
