From the Departments of Plastic and Reconstructive Surgery.
Department of Plastic, Reconstructive, and Aesthetic Surgery, Toyama University Hospital.
Plast Reconstr Surg. 2023 Jun 1;151(6):1157-1167. doi: 10.1097/PRS.0000000000010128. Epub 2023 Jan 2.
The selection of recipient vessels for free-flap breast reconstruction is important for the success of the surgery and the aesthetics of the breast mound. The thoracodorsal artery and vein (TDA/V) allow reconstruction without noticeable scars from the anterior view, but TDA/V exposure is an invasive and time-consuming process on sentinel node biopsy. This study aimed to determine the effectiveness of the lateral thoracic artery and vein (LTA/V) as recipient vessels by comparing them with the TDA/V.
This study included 270 flaps that underwent immediate free-flap breast reconstruction after nipple/skin-sparing mastectomy by lateral incision. The patients were categorized into two groups (LTA and TDA) based on the recipient vessel selected.
The LTA and TDA groups comprised 78 and 192 flaps, respectively. Among the 131 short and small pedicle flaps, such as gluteal artery perforator flap and profunda artery perforator flap, 65 (50%) used the LTA as the recipient vessel. The external diameters of the LTA/LTV (median, 1.2 mm/1.5 mm) were significantly lower than those of the TDA/TDV (median, 1.65 mm/2.0 mm). The LTV was present in 94%, and the second vein was present in 49% of cases with anastomosis. No significant differences in flap-related complications were observed between the two groups.
The LTA/V can be used as recipient vessels for immediate free-flap reconstruction. Because of their superficial location and small caliber, they are easily accessible and suitable for short and small pedicle flaps.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
游离皮瓣乳房重建中，受区血管的选择对手术的成功和乳房外形的美观至关重要。胸背动脉和静脉（TDA/V）可使重建后从前侧观察不到明显的疤痕，但在进行前哨淋巴结活检时，TDA/V 的显露是一个具有侵入性且耗时的过程。本研究旨在通过比较胸外侧动脉和静脉（LTA/V）与 TDA/V，确定其作为受区血管的有效性。
本研究纳入了 270 例通过侧切口行保留乳头/皮肤乳房切除术即刻游离皮瓣乳房重建的患者。根据选择的受区血管将患者分为 LTA 组和 TDA 组。
LTA 组和 TDA 组分别包括 78 例和 192 例皮瓣。在 131 例短小微蒂皮瓣中，如臀上动脉穿支皮瓣和股深动脉穿支皮瓣，有 65 例（50%）使用 LTA 作为受区血管。LTA/LTV 的外径（中位数，1.2mm/1.5mm）显著低于 TDA/TDV 的外径（中位数，1.65mm/2.0mm）。LTV 存在于 94%的病例中，有吻合的 49%病例存在第二静脉。两组间皮瓣相关并发症无显著差异。
LTA/V 可作为即刻游离皮瓣重建的受区血管。由于其位置表浅、口径较小，易于触及，适用于短小微蒂皮瓣。
临床问题/证据水平：治疗性，III 级。
