Geierlehner Alexander, Horch Raymund E, Ludolph Ingo, Arkudas Andreas
Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
J Pers Med. 2022 Mar 16;12(3):482. doi: 10.3390/jpm12030482.
Background: Vascular patency is the key element for high flap survival rates. The purpose of this study was to assess and compare the blood flow characteristics of deep inferior epigastric perforator (DIEP) and muscle-sparing transverse rectus abdominis musculocutaneous (ms-TRAM) flaps for autologous breast reconstruction. Methods: This prospective clinical study combined Transit-Time Flowmetry and microvascular Indocyanine Green Angiography for the measurement of blood flow volume, vascular resistance, and intrinsic transit time. Results: Twenty female patients (mean age, 52 years) received 24 free flaps (14 DIEP and 10 ms-TRAM flaps). The mean arterial blood flow of the flap in situ was 7.2 ± 1.9 mL/min in DIEP flaps and 11.5 ± 4.8 mL/min in ms-TRAM flaps (p < 0.05). After anastomosis, the mean arterial blood flow was 9.7 ± 5.6 mL/min in DIEP flaps and 13.5 ± 4.2 mL/min in ms-TRAM flaps (p = 0.07). The arterial vascular resistance of DIEP flaps was significantly higher than that of ms-TRAM flaps. The intrinsic transit time of DIEP flaps was 52 ± 18 s, and that of ms-TRAM flaps was 33 ± 11 s (p < 0.05). The flap survival rate was 100%. One DIEP flap with the highest intrinsic transit time (77 s) required surgical revision due to arterial thrombosis. Conclusion: In this study, we established the blood flow characteristics of free DIEP and ms-TRAM flaps showing different blood flow rates, vascular resistances, and intrinsic transit times. These standard values will help to determine the predictive values for vascular compromise, hence improving the safety of autologous breast reconstruction procedures.
血管通畅是皮瓣高成活率的关键因素。本研究旨在评估和比较腹壁下深动脉穿支（DIEP）皮瓣和保留肌肉的腹直肌肌皮（ms-TRAM）皮瓣用于自体乳房重建时的血流特征。方法：这项前瞻性临床研究结合了渡越时间血流测量法和微血管吲哚菁绿血管造影术来测量血流量、血管阻力和固有渡越时间。结果：20例女性患者（平均年龄52岁）接受了24例游离皮瓣移植（14例DIEP皮瓣和10例ms-TRAM皮瓣）。原位皮瓣的平均动脉血流量在DIEP皮瓣中为7.2±1.9 mL/分钟，在ms-TRAM皮瓣中为11.5±4.8 mL/分钟（p<0.05）。吻合后，DIEP皮瓣的平均动脉血流量为9.7±5.6 mL/分钟，ms-TRAM皮瓣为13.5±4.2 mL/分钟（p=0.07）。DIEP皮瓣的动脉血管阻力显著高于ms-TRAM皮瓣。DIEP皮瓣的固有渡越时间为52±18秒，ms-TRAM皮瓣为33±11秒（p<0.05）。皮瓣成活率为100%。1例固有渡越时间最长（77秒）的DIEP皮瓣因动脉血栓形成需要手术修复。结论：在本研究中，我们确定了游离DIEP皮瓣和ms-TRAM皮瓣的血流特征，显示出不同的血流速度、血管阻力和固有渡越时间。这些标准值将有助于确定血管受损的预测值，从而提高自体乳房重建手术的安全性。
