Frank Katharina, Ströbel Armin, Ludolph Ingo, Hauck Theresa, May Matthias S, Beier Justus P, Horch Raymund E, Arkudas Andreas
Laboratory for Tissue Engineering and Regenerative Medicine, Department of Plastic and Hand Surgery, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
Center for Clinical Studies, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany.
J Pers Med. 2022 Apr 28;12(5):701. doi: 10.3390/jpm12050701.
Background: Deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle flaps are commonly used flaps for autologous breast reconstruction. CT-angiography allows to analyse the perforator course preoperatively. Our aim was to compare the different aspects of perforator anatomy in the most detailed study. Methods: CT-angiographies of 300 female patients with autologous breast reconstruction of 10 years were analysed regarding the anatomy of the deep inferior epigastric artery and every perforator. Results: Overall, 2260 perforators were included. We identified correlations regarding the DIEA branching point and number of perforators and their intramuscular course. The largest perforator emerged more often from the medial branch of the DIEA than the smaller perforators (70% (416/595) vs. 54% (878/1634), p < 0.001) and more often had a direct connection to the SIEV (large 67% (401/595) vs. small 39% (634/1634), p < 0.01). Medial row perforators were larger than the laterals (lateral 1.44 mm ± 0.43 (n = 941) vs. medial 1.58 mm ± 0.52 (n = 1304) (p < 0.001)). The larger and more medial the perforator, the more likely it was connected to the SIEV: perforators with direct connection to the SIEV had a diameter of 1.65 mm ± 0.53 (n = 1050), perforators with indirect connection had a diameter of 1.43 ± 0.43 (n = 1028), perforators without connection had a diameter of 1.31 mm ± 0.37 (n = 169) (p < 0.001). Medial perforators were more often directly connected to the SIEV than lateral perforators (medial 56% (723/1302) vs. lateral 35% (327/941), p < 0.001). A lateral perforator more often had a short intramuscular course than medial perforators (69% (554/800) vs. 45% (474/1055), p < 0.001), which was also more often observed in the case of a small perforator and a caudal exit of the rectus sheath. Conclusion: The largest perforator emerges more often from the medial branch of the DIEA and frequently has a direct connection to the SIEV, making medial row perforators ideal for DIEP flap transplantation.
腹壁下深动脉穿支皮瓣和保留肌肉的腹直肌肌皮瓣是自体乳房重建常用的皮瓣。CT血管造影术可在术前分析穿支走行。我们的目的是在最详细的研究中比较穿支解剖结构的不同方面。方法：对300例接受自体乳房重建10年的女性患者的CT血管造影进行分析，观察腹壁下深动脉及各穿支的解剖结构。结果：共纳入2260个穿支。我们确定了腹壁下深动脉分支点、穿支数量及其肌内行径之间的相关性。最大穿支较其他较小穿支更常发自腹壁下深动脉的内侧分支（70%（416/595）对54%（878/1634），p<0.001），且与腹壁浅静脉直接相连的情况更常见（大穿支67%（401/595）对小穿支39%（634/1634），p<0.01）。内侧排穿支大于外侧穿支（外侧1.44 mm±0.43（n = 941）对内侧1.58 mm±0.52（n = 1304）（p<0.001））。穿支越大且越靠近内侧，与腹壁浅静脉相连的可能性越大：与腹壁浅静脉直接相连的穿支直径为1.65 mm±0.53（n = 1050），间接相连的穿支直径为1.43±0.43（n = 1028），无连接的穿支直径为1.31 mm±0.37（n = 169）（p<0.001）。内侧穿支比外侧穿支更常直接与腹壁浅静脉相连（内侧56%（723/1302）对外侧35%（327/941），p<0.001）。外侧穿支的肌内行径较内侧穿支更常较短（69%（554/800）对45%（474/1055），p<0.001），在小穿支和腹直肌鞘尾侧穿出的情况下也更常观察到这种情况。结论：最大穿支更常发自腹壁下深动脉的内侧分支，且常与腹壁浅静脉直接相连，这使得内侧排穿支成为腹壁下深动脉穿支皮瓣移植的理想选择。
