Reevaluation of Recipient Vessel Selection in Breast Free Flap Reconstruction

IF 1.5 3区医学 Q3 SURGERY

Microsurgery Pub Date : 2024-09-28 DOI:10.1002/micr.31222

Mehdi S. Lemdani, Dustin T. Crystal, Jane N. Ewing, Zachary Gala, Chris Amro, Said C. Azoury, Robyn B. Broach, Irfan A. Rhemtulla, Joseph M. Serletti

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引用次数: 0

Abstract

Background

Current consensus has established the internal mammary vessels (IMV) over the thoracodorsal vessels (TDV) as the preferred recipients for microvascular breast reconstruction due to their superior flow rates and long-established outcomes. Yet, there are occurrences where the IMVs are not reliable and may subsequently prompt intraoperative decision-making. Several options exist, including the contralateral IMVs, thoracoacromial vessels, and TDVs. The appropriate sequence for vessel choice is not universally agreed upon. This study reevaluates the TDVs to highlight their viability as a second-line intraoperative alternative to the IMV and provide reference to the straightforward dissection required for harvest.

Methods

A retrospective, single-institution, breast-level analysis examining 4754 breast free flaps from 2978 patients undergoing bilateral free flap reconstruction was conducted. Postoperative complications within 180 days were evaluated, and cohorts based on anatomic anastomosis (IMV vs. TDV) were created to compare outcomes. Subanalysis was conducted based on flap laterality as well as whether a flap was planned or converted intraoperatively.

Results

Of 4754 breast free flaps, 4269 (89.8%) used the IMV while 485 (10.2%) used the TDV. Most complication rates between the TVD and IMV were not significantly different. Rates of flap loss were 1.0% and 1.2% for the IMV and TDV anastomosis (p = 0.59). IMV and TDV anastomosed flaps experienced similar rates of fat necrosis (6.3% vs. 6.2%, p = 0.915). However, multivariable analysis of all breasts regardless of laterality showed that skin necrosis was significantly less likely in TDV breasts (OR 0.45, 95% CI 0.29–0.71, p < 0.001).

Conclusions

Given the relative similarity in cohort outcomes, TDV anastomosis can be considered a viable alternative to the IMV when the IMV is unavailable or technically disadvantageous. The TDV artery remains a robust and reliable option in the present-day plastic surgeon's repertoire for breast reconstruction.

Abstract Image

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重新评估乳房游离皮瓣重建中受体血管的选择。

背景：目前的共识是，乳腺内血管（IMV）比胸背血管（TDV）更适合作为乳房微血管重建的受体，因为它们具有更高的流速和长期公认的疗效。然而，在某些情况下，IMV 并不可靠，这可能会促使术中做出决策。目前有多种选择，包括对侧 IMV、胸骶血管和 TDV。选择血管的适当顺序并未得到普遍认同。本研究对 TDV 进行了重新评估，以强调其作为 IMV 的二线术中替代方案的可行性，并为采集所需的直接剥离提供参考：方法：对2978名接受双侧游离皮瓣重建术的患者的4754个乳房游离皮瓣进行了回顾性、单一机构、乳房层面的分析。对 180 天内的术后并发症进行了评估，并根据解剖吻合情况（IMV 与 TDV）进行了分组，以比较结果。根据皮瓣侧位以及皮瓣是否在术中计划或转换进行了子分析：结果：在4754个乳房游离皮瓣中，4269个（89.8%）使用了IMV，485个（10.2%）使用了TDV。TVD和IMV的大部分并发症发生率无明显差异。IMV和TDV吻合术的皮瓣脱落率分别为1.0%和1.2%（p = 0.59）。IMV和TDV吻合皮瓣的脂肪坏死率相似（6.3% vs. 6.2%，p = 0.915）。然而，对所有乳房（无论侧位如何）进行的多变量分析表明，TDV 乳房的皮肤坏死发生率明显较低（OR 0.45，95% CI 0.29-0.71，p 结论：TDV 乳房的皮肤坏死发生率明显较低：鉴于队列结果的相对相似性，当无法使用IMV或IMV在技术上处于劣势时，TDV吻合术可被视为IMV的可行替代方案。在当今整形外科医生的乳房重建手术中，TDV 动脉仍然是一种稳健可靠的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microsurgery 医学-外科

CiteScore

3.80

自引率

19.00%

发文量

128

审稿时长

4-8 weeks

期刊介绍： Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.