Nakamura Ryota, Tomita Koichi, Omura Nanaho, Nishimura Eriko, Higashimoto Kyuto, Kubo Tateki, Hikasa Hisashi
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Plastic and Reconstructive Surgery, Osaka Police Hospital, Osaka, Japan.
Plast Reconstr Surg Glob Open. 2022 Aug 24;10(8):e4484. doi: 10.1097/GOX.0000000000004484. eCollection 2022 Aug.
A superficial inferior epigastric artery (SIEA) flap can be an alternative to a deep inferior epigastric artery perforator (DIEAP) flap in cases where SIEAs are relatively well developed. Although an SIEA flap is less invasive than a DIEAP flap, the pedicles of the former are anatomically shorter, making it more difficult to choose recipient vessels when bilateral SIEAs are necessary. A 45-year-old female diagnosed with cancer of the left breast underwent mastectomy (specimen weight: 750 g) and immediate two-stage breast reconstruction using a free abdominal flap with bilateral pedicles was planned. Preoperative computed tomographic angiography showed that the bilateral DIEAPs in the flap were less than one millimeter in diameter, whereas the bilateral SIEAs were well developed enough for us to opt for a double-pedicled stacked SIEA flap. After the double-pedicled SIEA flap was elevated, folded, and temporarily placed in the subcutaneous pocket, the pedicle length on one side was found to be insufficient. Therefore, portions of the right composite deep inferior epigastric artery (DIEA) and vein (DIEV) grafts (roughly 7 cm) were collected from a short fasciotomy and anastomosed to the peripheral ends of the right SIEA and SIEV, respectively. Following this, the left SIEA and SIEV were antegradely anastomosed to the internal mammary artery and vein (IMA/IMV), while the DIEA/DIEV grafts were retrogradely anastomosed to the IMA/IMV, respectively. We recommend the proactive use of this method, as pedicle extension using the DIEA/DIEV grafts enables a higher degree of freedom in unilateral breast reconstruction using bilateral SIEA flaps.
在腹壁浅动脉（SIEA）相对发育良好的情况下，SIEA皮瓣可作为腹壁下动脉穿支（DIEAP）皮瓣的替代方案。尽管SIEA皮瓣的侵入性低于DIEAP皮瓣，但其蒂在解剖学上较短，在需要双侧SIEA皮瓣时选择受区血管更为困难。一名45岁诊断为左乳腺癌的女性接受了乳房切除术（标本重量：750 g），并计划立即采用带双侧蒂的游离腹部皮瓣进行两阶段乳房重建。术前计算机断层血管造影显示，皮瓣中的双侧DIEAP直径小于1毫米，而双侧SIEA发育良好，足以让我们选择双侧带蒂堆叠SIEA皮瓣。双侧带蒂SIEA皮瓣掀起、折叠并临时置于皮下袋后，发现一侧的蒂长度不足。因此，从一个短的筋膜切开术中采集了部分右侧复合腹壁下深动脉（DIEA）和静脉（DIEV）移植物（约7 cm），并分别与右侧SIEA和SIEV的外周端吻合。此后，将左侧SIEA和SIEV顺行吻合至胸廓内动脉和静脉（IMA/IMV），而DIEA/DIEV移植物分别逆行吻合至IMA/IMV。我们建议积极采用这种方法，因为使用DIEA/DIEV移植物进行蒂延长可在使用双侧SIEA皮瓣进行单侧乳房重建时提供更高的自由度。
