Allen Robert J, Ji Lixin, St Hilaire Hugo
From the LSU Health Sciences Center, Section of Plastic Surgery, New Orleans, LA.
Tulane University School of Medicine, Section of Plastic Surgery, New Orleans, LA.
Ann Plast Surg. 2025 Jun 1;94(6):658-662. doi: 10.1097/SAP.0000000000004345.
In 1863, Dr John Wood published the use of the pedicled superficial inferior epigastric artery (SIEA) flap for reconstruction of a forearm burn scar contracture. The first successful cutaneous free flap reported by Taylor and Daniel in 1973 was an SIEA free flap. Many thought mistakenly this first "groin flap" was based on the superficial circumflex iliac artery (SCIA). Although Taylor and Daniel planned on using the SCIA, it was quite small and the SIEA was much larger and more suitable for anastomosis to the recipient artery. The first SIEA flap for breast reconstruction was at Charity Hospital in New Orleans in 1989. We present our experience with 408 SIEA flaps for breast reconstruction. Our methods and techniques have continually evolved over the years. The SIEA breast reconstruction is the only technique using abdominoplasty territory that does not involve opening the anterior rectus sheath or the oblique fascia and muscles, resulting in the least donor-site morbidity of all abdominal based breast flaps. Our SIEA flap survival rate has been 97% over the past 35 years. The superficial inferior epigastric system is the key to understanding the blood supply of the lower abdomen.
A retrospective review of 408 SIEA breast reconstructions performed since 1989 was conducted. Patients were selected based on preoperative Doppler assessment of the SIEA, with 1.2-1.5 mm considered adequate. A subset underwent surgical delay to enhance arterial caliber. Outcomes assessed included flap survival, complications, and failure rates.
Flap survival was 97%. The SIEA flap can be used in 40% of patients based on our experience. Delayed SIEA flaps had no failures and reduced fat necrosis (0% vs 15%). Complications included partial ischemic necrosis (4%) and donor-site seromas or hematomas. A dual-plane approach with SIEA and DIEP flaps was used when increased volume of flap perfusion was needed.
The SIEA flap offers minimal donor-site morbidity but is limited by absent or inadequate artery diameter in approximately 60% of patients. The delay phenomenon increases flap vascularity and territory. Our findings support its integration into reconstructive practice, alone or combined with DIEP flaps, to optimize outcomes.
1863年，约翰·伍德医生发表了关于使用带蒂腹壁浅动脉（SIEA）皮瓣修复前臂烧伤瘢痕挛缩的文章。1973年，泰勒和丹尼尔报道的首例成功的游离皮瓣是SIEA游离皮瓣。许多人错误地认为这第一个“腹股沟皮瓣”是基于旋髂浅动脉（SCIA）的。尽管泰勒和丹尼尔原本计划使用SCIA，但它非常细小，而SIEA要大得多，更适合与受区动脉进行吻合。1989年，新奥尔良慈善医院开展了首例用于乳房重建的SIEA皮瓣手术。我们介绍了我们使用408例SIEA皮瓣进行乳房重建的经验。多年来，我们的方法和技术不断发展。SIEA乳房重建是唯一一种利用腹壁成形区域且不涉及打开腹直肌前鞘或斜筋膜及肌肉的技术，在所有基于腹部的乳房皮瓣中，其供区并发症最少。在过去35年里，我们的SIEA皮瓣存活率为97%。腹壁浅系统是理解下腹部血供的关键。
对1989年以来进行的408例SIEA乳房重建手术进行回顾性研究。根据术前对SIEA的多普勒评估选择患者，认为直径1.2 - 1.5毫米足够。一部分患者接受了手术延迟以增大动脉管径。评估的结果包括皮瓣存活情况、并发症和失败率。
皮瓣存活率为97%。根据我们的经验，40%的患者可以使用SIEA皮瓣。延迟的SIEA皮瓣没有失败病例，脂肪坏死率降低（0%对15%）。并发症包括部分缺血性坏死（4%）以及供区血清肿或血肿。当需要增加皮瓣灌注量时，采用SIEA和腹壁下动脉穿支（DIEP）皮瓣的双平面方法。
SIEA皮瓣供区并发症最少，但约60%的患者存在动脉缺如或管径不足的情况，这限制了其应用。延迟现象可增加皮瓣的血运和范围。我们的研究结果支持将其单独或与DIEP皮瓣联合应用于重建手术中，以优化手术效果。
