Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea.
Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea.
PLoS One. 2020 Nov 16;15(11):e0242214. doi: 10.1371/journal.pone.0242214. eCollection 2020.
Current clinical and anatomical studies show that the venous problem associated with the deep inferior epigastric perforator flap results from poor midline-crossing. We examined the venous anatomy of the infraumbilical midline area and the dynamic venous flow of the deep inferior epigastric perforator flap in nine fresh cadavers. All nine abdominal specimens were harvested between the subcostal margin and the groin crease. Two specimens were used to analyze the abdominal venous anatomy, one of which was divided into two hemi-abdominal specimens. The remaining seven specimens were harvested as deep inferior epigastric perforator flaps with one major paraumbilical perforator. Venous cannulation and serial angiographic agent injection were performed in several conditions. Each specimen was radiographed using a soft X-ray system. For additional information, computed tomography (CT) angiography-visualized superficial inferior epigastric veins (SIEVs) and the supraumbilical branch were analyzed. We noted that the venous drainage between the bilateral SIEVs was easier to configure in the supraumbilical area than in the infraumbilical area. Only one to two short polygonal venous networks connect the bilateral superficial inferior epigastric veins in the supraumbilical area; however, long and multiple polygonal venous networks connect the bilateral superficial inferior epigastric veins in the infraumbilical area, which could be a predisposing factor for venous congestion. The mean distance from the umbilicus upper border to evident supraumbilical midline crossover was 18.39±4.03 mm (range: 10.10-28.49) in CT angiograms. In cadaver specimens, the mean distance was 10.87±4.85 mm (range: 4.6-18.9). Supraumbilical midline crossover was more favorable than infraumbilical midline crossover in venous flow.
目前的临床和解剖学研究表明，与深部腹壁下血管穿支皮瓣相关的静脉问题源于中线交叉不良。我们检查了脐下中线区域的静脉解剖结构和深部腹壁下血管穿支皮瓣的动态静脉血流，在 9 具新鲜尸体中进行了研究。所有 9 个腹部标本均取自肋缘和腹股沟皱襞之间。2 个标本用于分析腹部静脉解剖结构，其中 1 个分为两个半腹部标本。其余 7 个标本作为深部腹壁下血管穿支皮瓣，带有 1 个主要脐旁穿支。在几种情况下进行静脉插管和连续血管造影剂注射。对每个标本进行软 X 射线系统拍摄。如需更多信息，还分析了计算机断层扫描（CT）血管造影可视化的腹壁下浅静脉（SIEV）和脐上分支。我们注意到，双侧 SIEV 之间的静脉引流在脐上区域比在脐下区域更容易配置。只有 1 到 2 个短的多边形静脉网络在脐上区域连接双侧腹壁下浅静脉；然而，长而多的多边形静脉网络在脐下区域连接双侧腹壁下浅静脉，这可能是静脉充血的一个诱发因素。CT 血管造影中，从脐上缘到明显脐上中线交叉的平均距离为 18.39±4.03mm（范围：10.10-28.49）。在尸体标本中，平均距离为 10.87±4.85mm（范围：4.6-18.9）。脐上中线交叉在静脉血流方面比脐下中线交叉更有利。
