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. 2024 Aug;95:97-103. doi: 10.1016/j.bjps.2024.05.044. Epub 2024 Jun 2.
In microvascular breast reconstruction, the internal mammary vein (IMV) has emerged as the most common recipient vein. The open-Y technique can increase the vessel diameter via the bifurcation site. This study aimed to investigate the open-Y technique for IMV.
The characteristics and details of the operative procedure in patients who had undergone unilateral breast reconstruction with and without the open-Y approach for the free abdominal flap were compared. Differences in IMV anastomosis site (the bifurcation of the main duct or that of the perforator branch) were also compared in patients with the open-Y technique. The open-Y technique was performed on the IMV side.
The open-Y and conventional groups included 127 and 62 patients, respectively. The main duct diameter of IMV was significantly smaller (median 2.5 vs. 3.0 mm, P < 0.001), and the rate of right-sided anastomosis (47.2 vs. 82.3%, P < 0.001) was significantly lower in the open-Y group. When comparing the main duct and perforator groups, the branch diameter (1.8 vs. 1.0 mm, P < 0.001) and the diameter after the open-Y technique (5.0 vs. 3.9 mm, P < 0.001) were significantly higher, and the angle of bifurcation (45° vs. 60°, P = 0.007) was significantly lower in the main duct group.
Given a small venous diameter, the open-Y technique is superior, especially for left-sided breast reconstruction. Owing to the lower angle of bifurcation and large diameter, the open-Y technique at the main duct bifurcation of IMV causes less turbulence in the blood flow.
The open-Y technique is especially effective for left-sided breast reconstruction. Considering the lower angle of bifurcation and large diameter, the open-Y technique at the main duct bifurcation of the internal mammary vein causes less turbulence in the blood flow.
在微血管乳房重建中，内乳静脉（IMV）已成为最常见的受植静脉。Y 形切开术可通过分叉部位增加血管直径。本研究旨在探讨 IMV 的 Y 形切开术。
比较了行游离腹部皮瓣单侧乳房重建的患者中，应用和未应用 Y 形切开术的 IMV 吻合部位（主干分叉或穿支分支分叉）的特点和手术细节。比较了 Y 形切开术患者的 IMV 侧 Y 形切开术。
Y 形切开组和常规组分别纳入 127 例和 62 例患者。IMV 主干直径明显较小（中位数 2.5 对 3.0mm，P<0.001），右侧吻合率（47.2%对 82.3%，P<0.001）明显较低。比较主干和穿支组时，分支直径（1.8 对 1.0mm，P<0.001）和 Y 形切开术后直径（5.0 对 3.9mm，P<0.001）明显较高，主干分叉角（45°对 60°，P=0.007）明显较低。
由于静脉直径较小，Y 形切开术更具优势，尤其是左侧乳房重建。由于分叉角度较低和直径较大，IMV 主干分叉处的 Y 形切开术使血流中的湍流减少。
鉴于静脉直径较小，Y 形切开术对左侧乳房重建尤其有效。考虑到较低的分叉角度和较大的直径，Y 形切开术在内乳静脉主干分叉处可减少血流中的湍流。
