Feng L J
Section of Microvascular Surgery, Mount Sinai Medical Center, Cleveland, Ohio, USA.
Plast Reconstr Surg. 1997 Feb;99(2):405-16. doi: 10.1097/00006534-199702000-00015.
The internal mammary vessels as recipient site for free flaps in breast reconstruction were investigated in this paper because of their ideal location for breast reconstruction. Comparisons were made with the thoracodorsal vessels in terms of external vessel diameter, vessel size discrepancy, flap loss and reexploration rates, and ease of flap placement. Eighty-one patients underwent 110 breast free-flap reconstructions (92 TRAM flaps and 18 superior gluteal flaps) between 1988 and 1994. Vessel size measurements were available on 75 flaps. The internal mammary artery diameter (2.36 +/- 0.50 mm, n = 51) was significantly larger than the thoracodorsal artery diameter (1.79 +/- 0.34 mm, n = 23; p < 0.001). There was no significant difference between the diameters of the internal mammary vein 2.6 +/- 0.58 mm, n = 52) and thoracodorsal vein (2.51 +/- 0.50 mm, n = 23; p = 0.93). The right internal mammary artery (2.52 +/- 0.51 mm) was significantly larger than the left internal mammary artery (2.30 +/- 0.55 mm; p = 0.046). The right internal mammary vein (2.89 +/- 0.56 mm) also was significantly larger than the left internal mammary vein (2.31 +/- 0.48 mm; p = 0.002). In terms of vessel size discrepancy, the internal mammary recipient artery tended to be greater in size than the TRAM flap donor artery (p = 0.003), while the thoracodorsal recipient artery tended to be smaller than the TRAM flap donor artery (p = 0.002). Flap failures and flap reexplorations occurred in the group using the thoracodorsal vessels but not in the internal mammary group. Correct flap placement using the internal mammary recipient site was achieved more easily for both unilateral and bilateral reconstructions because of the avoidance of lateral fullness and medial deficiency problems. The internal mammary recipient site is an important and at times superior alternative to the axillary recipient site because of its larger artery, especially when the axilla is scarred. For smaller free flaps such as a hemi-TRAM flap, as in bilateral TRAM flap reconstructions, the internal mammary site is invaluable because this recipient site allows exact placement of a smaller flap in the breast area.
本文对胸廓内血管作为乳房重建中游离皮瓣受区进行了研究，因其在乳房重建中位置理想。将其与胸背血管在血管外径、血管尺寸差异、皮瓣丢失及再次探查率以及皮瓣放置的难易程度等方面进行了比较。1988年至1994年间，81例患者接受了110次乳房游离皮瓣重建手术（92例横行腹直肌肌皮瓣和18例臀上动脉穿支皮瓣）。75例皮瓣有血管尺寸测量数据。胸廓内动脉直径（2.36±0.50mm，n = 51）显著大于胸背动脉直径（1.79±0.34mm，n = 23；p < 0.001）。胸廓内静脉直径（2.6±0.58mm，n = 52）与胸背静脉直径（2.51±0.50mm，n = 23；p = 0.93）之间无显著差异。右胸廓内动脉（2.52±0.51mm）显著大于左胸廓内动脉（2.30±0.55mm；p = 0.046）。右胸廓内静脉（2.89±0.56mm）也显著大于左胸廓内静脉（2.31±0.48mm；p = 0.002）。在血管尺寸差异方面，胸廓内受区动脉往往比横行腹直肌肌皮瓣供区动脉大（p = 0.003），而胸背受区动脉往往比横行腹直肌肌皮瓣供区动脉小（p = 0.002）。使用胸背血管的组出现了皮瓣失败和皮瓣再次探查情况，而胸廓内血管组未出现。由于避免了外侧丰满和内侧不足问题，对于单侧和双侧重建，使用胸廓内受区更容易实现皮瓣的正确放置。胸廓内受区是腋窝受区重要且有时更优的替代选择，因为其动脉较大，尤其是当腋窝有瘢痕时。对于较小的游离皮瓣，如双侧横行腹直肌肌皮瓣重建中的半横行腹直肌肌皮瓣，胸廓内受区非常重要，因为该受区能将较小的皮瓣准确放置在乳房区域。
