Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK.
Department of Hand and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
Microsurgery. 2024 Jan;44(1):e31105. doi: 10.1002/micr.31105. Epub 2023 Sep 7.
The selection of reliable recipient vessels is essential for successful free tissue transfer. The use of internal mammary intercostal perforators (IMAPs), instead of the internal mammary vessels as the recipient vessels, has been described in breast reconstruction. Debates exist regarding the reliability of these perforators as recipient vessels because of their variability in location and caliber. The aim of this paper was to conduct a systematic literature review and meta-analysis to determine the reliability of the IMAPs as recipient vessels.
A systematic literature review was performed on the "PubMed," "Medline," "Ovid," and "Cochrane library" databases for articles published from January 1990 to March 2021. Exclusion criteria were non-English studies, reports with case number less than 5, cadaveric or animal studies, and studies with incomplete postoperative outcomes. The reliability of using IMAPs for breast reconstruction was determined by assessing the reported rates of partial or complete flap failure and other complications (fat necrosis, skin necrosis, and requirement for revision surgery).
Three hundred and sixteen cases in 13 studies were included for further analysis with more than 85% of the IMAPs suitable for anastomosis being located in the second and third intercostal spaces. Partial or total flap failure was reported in three of 316 patients (0.95%). The rate of other complications such as fat necrosis, skin necrosis, and requirement for revision surgery were all less than 5%.
With deliberate preoperative planning, delicate perioperative manipulation, and meticulous microvascular anastomosis, the internal mammary perforators can be used as reliable recipient vessels in microvascular breast reconstruction.
选择可靠的受区血管对于游离组织移植的成功至关重要。在乳房重建中，已经描述了使用肋间穿支（IMAPs）而不是内乳血管作为受区血管。由于这些穿支的位置和口径存在变异性，因此对于它们作为受区血管的可靠性存在争议。本文的目的是进行系统的文献回顾和荟萃分析，以确定 IMAPs 作为受区血管的可靠性。
对“PubMed”、“Medline”、“Ovid”和“Cochrane 图书馆”数据库进行了系统的文献回顾，检索了 1990 年 1 月至 2021 年 3 月发表的文章。排除标准为非英语研究、病例数少于 5 例的报告、尸体或动物研究以及术后结果不完整的研究。通过评估报告的部分或完全皮瓣失败以及其他并发症（脂肪坏死、皮肤坏死和需要修正手术）的发生率，来确定使用 IMAPs 进行乳房重建的可靠性。
13 项研究中的 316 例病例被纳入进一步分析，超过 85%的 IMAPs 适合在第二和第三肋间进行吻合。在 316 例患者中有 3 例（0.95%）发生部分或完全皮瓣失败。其他并发症的发生率，如脂肪坏死、皮肤坏死和需要修正手术，均小于 5%。
通过精心的术前规划、精细的围手术期操作和细致的微血管吻合，内乳穿支可以作为微血管乳房重建中可靠的受区血管。
