Department of Plastic and Reconstructive Surgery, Chiba Cancer Center Hospital, Japan.
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Faculty of Medicine, Japan.
J Plast Reconstr Aesthet Surg. 2023 Sep;84:54-61. doi: 10.1016/j.bjps.2023.05.039. Epub 2023 May 19.
Heparin prophylaxis for venous thromboembolism can be used in microsurgery. If vein anastomosis is performed before the artery, heparin irrigation into the artery can be performed locally without systematic effect. This study aimed to introduce this "intraflap perfusion procedure" in autologous breast reconstruction.
Among the 220 patients with unilateral breast cancer who had received the free abdominal flap, we retrospectively compared those that had undergone the intraflap perfusion procedure (n = 108) and those who did not (n = 112). A 10 mL injection of heparinized physiological saline solution (100 units/mL) was administered into the deep inferior epigastric artery. Intraflap perfusion was performed before, during, and after vein anastomosis, without the vessel clip of the vein. Artery anastomosis was performed without the use of a vein clamp. Further, vein anastomosis was performed tightly to prevent leakage from the vein anastomosis site during artery anastomosis.
The rates of superficial inferior epigastric vein (SIEV) superdrainage (18.5% vs. 42.0%, P < 0.001), and intraoperative flap congestion (0.9% vs. 8.0%, P = 0.01) were significantly lower in patients undergoing this procedure. There were no significant differences regarding other factors (age, BMI, laterality, comorbidities, and other operative details).
Intraflap perfusion prevented long-term stasis at the venous anastomosis site and capillary level. It could reduce flap congestion. SIEV superdrainage was performed to manage flap congestion, particularly in patients who did not undergo this procedure. Consequently, it can be inferred that this procedure reduces the rate of superdrainage.
静脉血栓栓塞症的肝素预防可用于显微外科手术。如果在动脉吻合之前进行静脉吻合，可以在不产生系统作用的情况下局部进行肝素灌洗。本研究旨在介绍这种“皮瓣内灌注程序”在自体乳房重建中的应用。
在接受游离腹部皮瓣的 220 例单侧乳腺癌患者中，我们回顾性比较了行皮瓣内灌注术（n=108）和未行皮瓣内灌注术（n=112）的患者。在深腹壁下动脉内注射 10ml 肝素生理盐水（100 单位/ml）。在静脉吻合前、中、后进行皮瓣内灌注，同时不夹闭静脉。行动脉吻合时不使用静脉夹。此外，为了防止在动脉吻合时静脉吻合口漏血，进行紧密的静脉吻合。
行该手术患者的腹壁下浅静脉（SIEV）引流过度（18.5%比 42.0%，P<0.001）和术中皮瓣淤血（0.9%比 8.0%，P=0.01）的发生率显著降低。其他因素（年龄、BMI、侧别、合并症和其他手术细节）无显著差异。
皮瓣内灌注防止了静脉吻合口和毛细血管水平的长期淤血。它可以减少皮瓣淤血。行 SIEV 引流术来处理皮瓣淤血，特别是在未行该手术的患者中。因此，可以推断该手术可降低引流过度的发生率。
