From the School of Medicine.
Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center.
Ann Plast Surg. 2022 Jun 1;88(5 Suppl 5):S414-S421. doi: 10.1097/SAP.0000000000003160.
The superficial inferior epigastric artery (SIEA) flap allows transfer of tissue without violating the rectus fascia. Traditionally it is best used in single stage reconstruction when vessel caliber is 1.5 mm; 56% to 70% of SIEAs are less than 1.5 mm and, therefore, not reliable. We aim to demonstrate the increased reliability of SIEA through surgical delay by quantifying reconstructive outcomes and delay-induced hemodynamic alterations.
Patients presenting for autologous breast reconstruction between May 2019 and October 2020 were evaluated with preoperative imaging and received either delayed SIEA or delayed deep inferior epigastric (DIEP) reconstruction based on clinical considerations, such as prior surgery and perforator size/location. Prospective data were collected on operative time, length of stay, and complications. Arterial diameter and peak flow were quantified with Doppler ultrasound predelay and postdelay.
Seventeen delayed SIEA flaps were included. The mean age (± SD) was 46.2 ± 10.55 years, and body mass index was 26.7 ± 4.26 kg/m2. Average hospital stay after delay was 0.85 ± 0.90 days, and duration before reconstruction was 6 days to 14.5 months. Delay complications included 1 abdominal seroma (n = 1, 7.7%). Superficial inferior epigastric artery diameter predelay (mean ± 95% confidence interval) was 1.37 ± 0.20 mm and increased to 2.26 ± 0.24 mm postdelay. A significant increase in diameter was noted 0.9 ± 0.22 mm (P < 0.0001). Mean peak flow predelay was 14.43 ± 13.38 cm/s and 44.61 ± 60.35 cm/s (n = 4, P = 0.1822) postdelay.
Surgical delay of the SIEA flap augments SIEA diameter, increasing the reliability of this flap for breast reconstruction. Superficial inferior epigastric artery delay results in low rates of complications and no failures in our series. Although more patients are needed to assess increase in arterial flow, use of surgical delay can expand the use of SIEA flap reconstruction and reduce abdominal morbidity associated with abdominal flap breast reconstruction.
腹壁浅动脉（SIEA）皮瓣可在不破坏腹直肌筋膜的情况下转移组织。传统上，当血管直径为 1.5 毫米时，它最适合用于单阶段重建；56%至 70%的 SIEA 小于 1.5 毫米，因此不可靠。我们旨在通过量化重建结果和延迟诱导的血液动力学改变来证明 SIEA 通过手术延迟的可靠性增加。
2019 年 5 月至 2020 年 10 月期间接受自体乳房重建的患者接受术前影像学评估，并根据临床考虑（如先前手术和穿支大小/位置）接受延迟 SIEA 或延迟深部腹壁下动脉（DIEP）重建。前瞻性收集手术时间、住院时间和并发症的数据。多普勒超声预延迟和后延迟时量化动脉直径和峰值流量。
纳入了 17 例延迟 SIEA 皮瓣。平均年龄（±标准差）为 46.2±10.55 岁，体重指数为 26.7±4.26kg/m2。延迟后的平均住院时间为 0.85±0.90 天，重建前的时间为 6 天至 14.5 个月。延迟并发症包括 1 例腹部血清肿（n=1，7.7%）。SIEA 直径预延迟（平均值±95%置信区间）为 1.37±0.20mm，后延迟增加至 2.26±0.24mm。直径显著增加 0.9±0.22mm（P<0.0001）。预延迟平均峰值流量为 14.43±13.38cm/s，后延迟为 44.61±60.35cm/s（n=4，P=0.1822）。
SIEA 皮瓣的手术延迟增加了 SIEA 直径，提高了该皮瓣用于乳房重建的可靠性。SIEA 延迟导致并发症发生率低，且在我们的系列中没有失败。尽管需要更多患者来评估动脉流量的增加，但手术延迟的使用可以扩大 SIEA 皮瓣重建的应用，并减少与腹部皮瓣乳房重建相关的腹部发病率。
