Franchi Alberto, Patanè Luca, Hummel Carmen Elena, Walber Jonas, Najaf Zadeh Shadi, Jandali Abdul Rahman, Jung Florian
From the Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland.
Department of Surgery, Plastic Surgery Unit, Sapienza University of Rome, Rome, Italy.
Plast Reconstr Surg Glob Open. 2024 Oct 28;12(10):e6252. doi: 10.1097/GOX.0000000000006252. eCollection 2024 Oct.
Despite its many advantages, the deep inferior epigastric artery perforator flap requires fascial incision and intramuscular dissection, which can lead to pain and weakening of the abdominal wall. The superficial inferior epigastric artery (SIEA) flap offers an alternative to avoid this damage but is often considered unreliable due to its variable anatomy. In this study, we report our experience in autologous breast reconstruction using either the superficial branch of the superficial circumflex iliac artery (SCIA-SB) or the SIEA as the sole flap pedicle.
A retrospective study was conducted from August 2022 to December 2023. A total of 17 patients underwent breast reconstruction with 18 flaps (1 bilateral and 16 unilateral reconstructions). The SCIA-SB (14 flaps) or SIEA (4 flaps) served as the exclusive arterial sources. Preoperative vessel identification was performed using color-coded duplex sonography, and the flap design was adjusted accordingly. Intraoperative flap perfusion was assessed via indocyanine green angiography. Demographic, intraoperative, and postoperative data were recorded.
The mean follow-up was 5.7 months (range: 3-17 mo). Of the 18 flaps, 1 was lost due to arterial insufficiency. Partial flap necrosis requiring revision occurred in 1 case, whereas minor complications (seroma, wound dehiscence, mastectomy skin necrosis, and infection) were observed in 7 patients.
In our experience, either the SCIA-SB or SIEA can be successfully used as a pedicle in autologous breast reconstruction, provided that the abdominal flap design is modified to include their functional angiosomes.
尽管腹壁下动脉穿支皮瓣有诸多优点，但需要切开筋膜并进行肌内解剖，这可能导致疼痛和腹壁薄弱。腹壁浅动脉（SIEA）皮瓣提供了一种避免这种损伤的替代方案，但由于其解剖结构多变，常被认为不可靠。在本研究中，我们报告了使用旋髂浅动脉浅支（SCIA-SB）或SIEA作为唯一皮瓣蒂进行自体乳房重建的经验。
对2022年8月至2023年12月进行回顾性研究。共有17例患者接受了18例皮瓣乳房重建（1例双侧和16例单侧重建）。SCIA-SB（14例皮瓣）或SIEA（4例皮瓣）作为唯一的动脉来源。术前使用彩色编码双功超声识别血管，并相应调整皮瓣设计。术中通过吲哚菁绿血管造影评估皮瓣灌注情况。记录人口统计学、术中及术后数据。
平均随访5.7个月（范围：3 - 17个月）。18例皮瓣中，1例因动脉供血不足而丢失。1例发生需要修复的部分皮瓣坏死，7例患者出现轻微并发症（血清肿、伤口裂开、乳房切除皮肤坏死和感染）。
根据我们的经验，SCIA-SB或SIEA均可成功用作自体乳房重建的蒂，前提是对腹部皮瓣设计进行修改，以纳入其功能性血管体。
