Kramer Aviv, Lava Christian X, Li Karen R, Berger Lauren E, Khayat Elias, Song David H
From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
Georgetown University School of Medicine, Washington, DC.
Ann Plast Surg. 2024 Aug 1;93(2):215-220. doi: 10.1097/SAP.0000000000003984. Epub 2024 Jun 18.
This study aims to compare perfusion dynamics using indocyanine green videoangiography before and after the creation of a second venous anastomosis between the superficial inferior epigastric vein and the retrograde internal mammary vein (IMV) in deep inferior epigastric perforator (DIEP) flap breast reconstructions.
Indocyanine green videoangiography performed during DIEP flap reconstructions was analyzed prospectively. The areas of interest were above the perforators with the highest intensity (complete perfusion), the most distal lateral edge of the flap (partial perfusion), and the next lowest intensity (ischemic). We compared the zone intensities before and after the second venous anastomosis, assessing venous drainage patency and functionality. Patient characteristics, operative details, and complications were collected.
Seven patients (10 breasts) underwent DIEP reconstruction. Mean age was 54.5 ± 12.4 years. Mean operative duration was 575.5 ± 172.6 minutes. Donors included DIEV (n = 10, 100.0%), superficial inferior epigastric vein (n = 9, 90.0%), and superficial circumflex epigastric vein (n = 1, 10.0%). All DIEVs were anastomosed to the antegrade IMV (n = 10, 100.0%). Superficial inferior epigastric veins were anastomosed to the retrograde IMV (n = 10, 100.0%). Mean peak intensities of the complete perfusion zone before and after the second venous anastomosis were 160.7 ± 42.1 and 188 ± 42.1, respectively ( P = 0.163). Mean peak intensities of the partial perfusion zone were 100.8 ± 21.5 and 152 ± 31.5, respectively ( P < 0.001). Mean peak intensities of the ischemic zone were 90.4 ± 37.4 and 143.4 ± 45.3, respectively ( P = 0.012).
These findings highlight the potential benefits of the super drainage technique in enhancing perfusion and reducing complications, emphasizing the need for further investigation and consideration of this technique in clinical practice.
本研究旨在比较在腹壁下深动脉穿支（DIEP）皮瓣乳房重建术中，在腹壁下浅静脉与逆行胸廓内静脉（IMV）之间建立第二静脉吻合前后，使用吲哚菁绿视频血管造影术观察灌注动力学的变化。
对DIEP皮瓣重建术中进行的吲哚菁绿视频血管造影术进行前瞻性分析。感兴趣的区域包括强度最高（完全灌注）的穿支上方区域、皮瓣最远端外侧边缘（部分灌注）以及强度次低（缺血）区域。我们比较了第二静脉吻合前后各区域的强度，评估静脉引流的通畅性和功能。收集患者特征、手术细节和并发症情况。
7例患者（10侧乳房）接受了DIEP重建术。平均年龄为54.5±12.4岁。平均手术时长为575.5±172.6分钟。供体血管包括腹壁下深静脉（n = 10，100.0%）、腹壁下浅静脉（n = 9，90.0%）和腹壁浅旋静脉（n = 1，10.0%）。所有腹壁下深静脉均与顺行胸廓内静脉吻合（n = 10，100.0%）。腹壁下浅静脉与逆行胸廓内静脉吻合（n = 10，100.0%）。第二静脉吻合前后完全灌注区的平均峰值强度分别为160.7±42.1和188±42.1（P = 0.163）。部分灌注区的平均峰值强度分别为100.8±21.5和152±31.5（P < 0.001）。缺血区的平均峰值强度分别为90.4±37.4和143.4±45.3（P = 0.012）。
这些发现突出了超级引流技术在增强灌注和减少并发症方面的潜在益处，并强调在临床实践中需要对该技术进行进一步研究和考虑。
