动脉耦合的临床应用以及乳内动脉和胸背动脉的组织形态学比较,以确保安全使用。

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-07-19 DOI:10.1002/micr.31214
Suphalerk Lohasammakul MD, Seok Joon Lee MD, Chaiyawat Suppasilp MD, Natawan Sirivongs MD, Kasem Koedpuech BSc, Terasut Numwong MD, Rosarin Ratanalekha MD, MSc, Hyun Ho Han MD, PhD
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引用次数: 0

摘要

背景:据报道,在乳房重建中,胸背动脉(TDA)的动脉耦合比乳腺内动脉(IMA)更有利。这种技术有助于克服在狭小、较深空间内的吻合问题。了解动脉的机械特性对乳房重建的安全和成功至关重要:回顾性分析了 2020 年至 2022 年期间由一名外科医生实施的腹部游离皮瓣乳房重建术。根据微吻合技术(手缝和耦合器装置)对患者进行分类,以比较血管翻修率。在10具新鲜尸体上对TDA和IMA的动脉耦合进行了组织形态学分析,以比较管壁厚度和成分,包括弹性纤维、平滑肌和胶原蛋白的密度:共纳入 309 例患者(339 例重建乳房)。TDA 手缝组(A)有 29 名患者,TDA 耦合器组(B)有 38 名患者,IMA 手缝组(C)有 242 名患者。A 组、B 组和 C 组的动脉翻修率分别为 0.00%(95%CI:0.00%-11.03%)、2.5%(95%CI:0.44%-12.88%)和 1.49%(95%CI:0.58%-3.77%),差异无统计学意义(P 值 = .694)。组织学上,IMA 和 TDA 的中膜和外膜厚度无明显差异。IMA 的弹性纤维密度(16.70%)明显高于 TDA(0.79%)(P 值 结论:与 IMA 相比,TDA 的组织学特征更有利于动脉耦合。在必须通过窄而深的切口进行 TDA 吻合的情况下,动脉耦合是一种安全的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A clinical application for arterial coupling and histomorphometric comparison of internal mammary and thoracodorsal arteries for safe use

Background

In breast reconstruction, arterial coupling has been reported to be more favorable in the thoracodorsal artery (TDA) than the internal mammary artery (IMA). This technique may help overcome anastomosis in a small, deep space. Understanding the arteries' mechanical properties is crucial for breast reconstruction's safety and success.

Methods

Abdominal-based free flap breast reconstructions performed by a single surgeon between 2020 and 2022 were retrospectively analyzed. The patients were classified by microanastomosis technique (handsewn and coupler device) to compare the rate of vascular revision. Histomorphometric analysis of arterial coupling in TDA and IMA was performed in 10 fresh cadavers for comparing wall thickness and composition, including densities of elastic fiber, smooth muscle, and collagen.

Results

A total of 309 patients (339 reconstructed breasts) were included. There were 29 patients in the TDA handsewn group (A), 38 patients in the TDA coupler group (B), and 242 patients in the IMA handsewn group (C). The rates of arterial revision in groups A, B, and C were 0.00% (95%CI: 0.00%–11.03%), 2.5% (95%CI: 0.44%–12.88%), and 1.49% (95%CI: 0.58%–3.77%), respectively, with no statistically significant differences (p-value = .694). Histologically, the thickness of the tunica media and adventitia between IMA and TDA showed no significant difference. The density of elastic fiber was significantly higher in IMA (16.70%) than in TDA (0.79%) (p-value <.001).

Conclusion

The histologic characteristics of TDA are more favorable for arterial coupling than those of IMA. Arterial coupling is a safe option in situations where TDA anastomosis must be performed through a narrow and deep incision.

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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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