使用下上腹浅动脉皮瓣进行乳房重建,并通过动静脉环拉长皮瓣蒂:病例报告。

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-05-08 DOI:10.1002/micr.31183
Wataru Otsuka MD, Ryo Karakawa MD, PhD, Hidehiko Yoshimatsu MD, PhD, Tomoyuki Yano MD, PhD
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引用次数: 0

摘要

为了减少腹痛和隆起等术后并发症,通常会选择表皮下上腹动脉(SIEA)皮瓣。然而,SIEA皮瓣直径小、蒂短等缺点给吻合或创建乳房下极带来了挑战。在此,我们报告了一例使用SIEA皮瓣进行乳房重建的病例,该皮瓣通过动静脉环(AV-loop)使用对侧浅表下上腹静脉(SIEV)移植物延长了蒂。一名 49 岁的女性接受了左侧全乳房切除术,并主要植入了组织扩张器。计划使用带蒂的SIEA皮瓣进行乳房重建。术前使用 48-MHz 超高频超声探头(Vevo MD 超声设备,Fujifilm Visual Sonics,荷兰阿姆斯特丹)对双侧 SIEA/SIEV 和髂浅周动脉及静脉(SCIA/SCIV)的运行模式、蒂长度和直径进行了评估。在皮瓣采集过程中,采集了对侧SIEV移植物,以创建一个房室环,用于拉长瓣梗。9 厘米长的移植物与左侧乳内动脉和静脉(IMA/IMV)吻合。皮瓣隆起后,在中点分割创建的房室环,并将其吻合到 SIEA 皮瓣的蒂部。SIEA皮瓣与SIEV动静脉环一起延伸,有助于隆乳下极,而不会有蒂扭结和牵拉的风险。术后过程顺利,患者在术后第7天出院。通过 AV 环路延长的瓣蒂长度防止了瓣蒂扭结,使皮瓣的定位更加自由,通过填充下极形成了美观的乳房轮廓。术前使用超高频超声波对血管进行精确评估,有助于制定细致的计划。如果外科医生希望尽量减少与其他腹部游离皮瓣相关的术中和术后并发症,这种方法不失为一种可行且有前景的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Breast reconstruction using a superficial inferior epigastric artery flap with pedicle elongation via an arteriovenous loop: A case report

Superficial inferior epigastric artery (SIEA) flap is often chosen to minimize postoperative complications such as abdominal pain and bulging. However, drawbacks, including a small diameter and a short pedicle, pose challenges in anastomosing or creating the lower pole of the breast. Here, we report a case of breast reconstruction using an SIEA flap with pedicle elongation via an arteriovenous loop (AV-loop) using a contralateral superficial inferior epigastric vein (SIEV) graft. A 49-year-old woman underwent a left total mastectomy with the primary insertion of a tissue expander. Breast reconstruction using an SIEA flap with pedicle elongation was planned. The running pattern, pedicle length, and diameter of bilateral SIEA/SIEV and superficial circumflex iliac artery and vein (SCIA/SCIV) were evaluated preoperatively using a 48-MHz probe of ultra-high-frequency ultrasonography (Vevo MD ultrasound device, Fujifilm Visual Sonics, Amsterdam, the Netherlands). During the flap harvesting, the contralateral SIEV graft was harvested to create an AV-loop for pedicle elongation. The 9 cm graft was anastomosed to the left internal mammary artery and vein (IMA/IMV). After the flap elevation, the created AV-loop was divided at the midpoint and anastomosed to the pedicle of the SIEA flap. The SIEA flap, extended with a SIEV AV-loop, facilitated the augmentation of the lower pole of the breast without the risk of pedicle kinking and pulling. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. The prolonged pedicle length via an AV-loop prevents the pedicle kinking and allows for positioning the flap more freely, resulting in an aesthetically good breast contour by filling in the lower pole. The precise preoperative evaluation of the vessels using ultra-high-frequency ultrasonography facilitated meticulous planning. In cases where surgeons aim to minimize intraoperative and postoperative complications associated with other abdominal free flaps, this method may be considered a viable and promising option.

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来源期刊
Microsurgery
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.
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