Vallas Agathoklis, Chrysikos Dimosthenis, Tsakotos George, Troupis Theodore
Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, GRC.
Anatomy and Surgical Anatomy: Orthopedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC.
Cureus. 2024 Nov 18;16(11):e73918. doi: 10.7759/cureus.73918. eCollection 2024 Nov.
This systematic review examines the impact of anatomical variations in the medial circumflex artery (MCA) on the outcomes of gracilis flap procedures in reconstructive surgery. Incorporating 16 studies, this review analyzes how different MCA variants influence the success rates of these procedures. Findings highlight critical MCA variations, including cases of split and double pedicles and differences in pedicle length and branching patterns, which can complicate flap harvesting and vascular anastomosis. The studies consistently underscore the need for precise preoperative imaging and intraoperative adaptability to manage these anatomical differences effectively. Notably, variants with shorter or branched pedicles present higher risks of partial flap loss and complications, particularly in autologous breast reconstruction and lower extremity repairs. The findings support the adoption of advanced imaging protocols, such as high-resolution Doppler and CT angiography, to enable detailed vascular mapping. Interdisciplinary collaboration among anatomists, radiologists, and surgeons is essential for developing comprehensive strategies tailored to individual anatomical landscapes, optimizing both the success and viability of gracilis flaps. The review emphasizes that understanding MCA variability is crucial for enhancing surgical precision and improving patient outcomes. Standardizing preoperative assessment protocols and exploring alternative flap techniques may mitigate risks associated with MCA variations, advancing the field of reconstructive surgery.
本系统评价探讨了旋股内侧动脉（MCA）的解剖变异对重建手术中股薄肌皮瓣手术效果的影响。该评价纳入了16项研究，分析了不同的MCA变异如何影响这些手术的成功率。研究结果突出了关键的MCA变异，包括分支和双蒂情况以及蒂长度和分支模式的差异，这些可能使皮瓣切取和血管吻合复杂化。这些研究一致强调，需要精确的术前影像学检查和术中适应性，以有效应对这些解剖差异。值得注意的是，蒂较短或有分支的变异存在皮瓣部分坏死和并发症的较高风险，尤其是在自体乳房重建和下肢修复中。研究结果支持采用先进的影像学检查方案，如高分辨率多普勒和CT血管造影，以实现详细的血管成像。解剖学家、放射科医生和外科医生之间的跨学科合作对于制定针对个体解剖结构的综合策略至关重要，这有助于优化股薄肌皮瓣的成功率和生存能力。该评价强调，了解MCA变异对于提高手术精度和改善患者预后至关重要。标准化术前评估方案并探索替代皮瓣技术可能会降低与MCA变异相关的风险，推动重建外科领域的发展。
