Tsuge Itaru, Saito Susumu, Munisso Maria Chiara, Kosaka Tomoko, Takaya Ayako, Liu Chang, Yamamoto Goshiro, Morimoto Naoki
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Plast Reconstr Aesthet Surg. 2024 Dec;99:1-10. doi: 10.1016/j.bjps.2024.09.010. Epub 2024 Sep 7.
The importance of the subcutaneous arterial network crossing the midline in transverse abdominal flaps has been reported. Photoacoustic tomography can be used to noninvasively visualize subcutaneous vascular networks. We applied this novel technology preoperatively in patients undergoing breast reconstruction to detect individual variations in the midline-crossing arteries.
Six patients scheduled to undergo breast reconstruction using free deep inferior epigastric artery perforator flaps were examined. Each scan of the 12 × 8-cm region took approximately 8 min. The accuracy of the tentative artery evaluation defined by photoacoustic tomography was compared with the arterial phase detected by intraoperative indocyanine green angiography. The number of perforator vessels used for the flap, surgical time for flap elevation, and perfusion area ratio were compared with those of the control group.
The average match rate between tentative artery prediction by photoacoustic tomography and arterial-phase assessment by intraoperative angiography in five patients was 79.8%. Each midline-crossing artery showed individual variations. The photoacoustic tomography group (PAT-1 to 5) showed 1.8 perforators per flap, 163 min for flap elevation, and 93% perfusion area, with no significant differences from the control group (N = 5). A 63-year-old woman (PAT-6) with abdominal scars, including a midline abdominal incision, showed a preserved midline-crossing artery. The planned single perforator deep inferior epigastric perforator flap was successfully applied to the contralateral perfusion area.
Photoacoustic tomography noninvasively visualizes the subcutaneous midline-crossing arterial networks. Understanding individual vascular variations can support preoperative planning and surgical indication of abdominal flaps, especially in patients with postsurgical scars.
已有报道指出，皮下动脉网络在横腹皮瓣中穿过中线的重要性。光声断层扫描可用于无创可视化皮下血管网络。我们在接受乳房重建的患者术前应用了这项新技术，以检测穿过中线动脉的个体差异。
对6例计划使用游离腹壁下深动脉穿支皮瓣进行乳房重建的患者进行检查。对12×8厘米区域的每次扫描大约需要8分钟。将光声断层扫描定义的暂定动脉评估准确性与术中吲哚菁绿血管造影检测的动脉期进行比较。将皮瓣使用的穿支血管数量、皮瓣掀起手术时间和灌注面积比与对照组进行比较。
5例患者光声断层扫描暂定动脉预测与术中血管造影动脉期评估的平均匹配率为79.8%。每条穿过中线的动脉都显示出个体差异。光声断层扫描组（PAT-1至5）每个皮瓣显示1.8个穿支，皮瓣掀起时间为163分钟，灌注面积为93%，与对照组（N = 5）无显著差异。一名63岁有腹部瘢痕（包括腹部中线切口）的女性（PAT-6）显示有一条保留的穿过中线的动脉。计划的单穿支腹壁下深穿支皮瓣成功应用于对侧灌注区域。
光声断层扫描可无创可视化皮下穿过中线的动脉网络。了解个体血管变异有助于支持腹部皮瓣的术前规划和手术指征，尤其是在有手术瘢痕的患者中。
