From the Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
Department of Plastic Surgery, Emergency Care and Trauma Division, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
Ann Plast Surg. 2023 Feb 1;90(2):140-143. doi: 10.1097/SAP.0000000000002978. Epub 2021 Sep 13.
Intraoperative venous congestion is a main complication in deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction. We present a pedicle measuring technique to precisely predict the length of pedicle needed in DIEP free flap, to improve the outcome, and to reduce the risk of donor site morbidity and complications.
A single-center, open-label, prospective, randomized study was carried out to access efficacy and safety of a pedicle measuring technique in 389 patients. Each patient received a delayed breast reconstruction using free unipedicled DIEP flap, and internal mammary vessels were chosen as recipient vessels. During the surgery, the conventional DIEP flap technique was used in the control group, in which the course of the pedicle was fully dissected. In the measuring group, the flap in setting way was decided preoperatively, the distance (A) between the internal mammary vessels (a) and the point of DIEP perforator into the subcutaneous tissue (b) was measured, and then the length (B) of the perforator (c) and the main trunk (d) is measured and dissected to achieve 1 cm longer than A.
There are 180 and 209 patients enrolled in the control and measuring group, respectively. Venous congestion occurred in 15 patients (8.3%) in the control group, and 1 patient (0.5%) in the measuring group ( P < 0.001). All the 16 patients were found venous thrombosis. Then successful free flap salvage surgeries were performed in 10 patients. Six patients (3.3%) had total flap necrosis due to recurrent venous thromboembolisms. Fat necrosis occurred in 16 patients (8.9%) in the control group, and 5 patients (2.4%) in the measuring group ( P = 0.006). Partial flap necrosis was found in 12 patients (6.7%) in the control group, and in 3 patients (1.4%) in the measuring group ( P = 0.008). Total flap necrosis occurred in 6 patients (3.3%) in the control group, but no (0%) patient in the measuring group ( P = 0.009).
Measurement of pedicle length for DIEP flap transferring in breast reconstruction is a reliable technique that could secure the DIEP free flap, reduce operative invasiveness, and lower the risk of complications considerably.
术中静脉淤血是深部腹壁下动脉穿支皮瓣（DIEP）乳房再造的主要并发症。我们提出了一种蒂测量技术，以精确预测 DIEP 游离皮瓣所需的蒂长度，从而改善手术效果，降低供区发病率和并发症的风险。
本研究为单中心、开放标签、前瞻性、随机研究，共纳入 389 例患者。每位患者均接受游离单蒂 DIEP 皮瓣延迟乳房再造，内乳血管作为受区血管。在手术中，对照组采用传统的 DIEP 皮瓣技术，完全游离蒂。在测量组中，术前决定皮瓣的放置方式，测量内乳血管（a）和 DIEP 穿支进入皮下组织（b）点之间的距离（A），然后测量穿支（c）和主干（d）的长度，并游离至比 A 长 1cm。
对照组和测量组分别纳入 180 例和 209 例患者。对照组有 15 例（8.3%）患者发生静脉淤血，测量组有 1 例（0.5%）患者发生（P＜0.001）。所有 16 例患者均发现静脉血栓形成。然后对 10 例患者成功进行了游离皮瓣挽救手术。6 例（3.3%）患者因静脉血栓再发出现全皮瓣坏死。对照组有 16 例（8.9%）患者发生脂肪坏死，测量组有 5 例（2.4%）患者发生（P=0.006）。对照组有 12 例（6.7%）患者发生部分皮瓣坏死，测量组有 3 例（1.4%）患者发生（P=0.008）。对照组有 6 例（3.3%）患者发生全皮瓣坏死，而测量组无（0%）患者发生（P=0.009）。
DIEP 皮瓣转移乳房再造中蒂长度的测量是一种可靠的技术，可以确保 DIEP 游离皮瓣的安全性，降低手术的侵袭性，显著降低并发症的风险。
