Abstract：
BACKGROUND: When performing breast reconstruction using a deep inferior epigastric artery (DIEA) perforator (DIEP) flap, including Hartrampf zone IV, the bipedicled DIEP flap has been argued to be necessary to ensure stable perfusion. However, a proximal medial branch (PMB), which is the most proximal perforator of DIEA, may make it possible to obtain adequate perfusion in a unilateral DIEP flap. This study aimed to clarify the detailed anatomical characteristics of PMB and its potential clinical applications in breast reconstruction.
METHODS: This retrospective study was conducted on breast reconstruction using the DIEP flap between May 2020 and July 2023. Data on PMB anatomy were collected from preoperative contrast-enhanced computed tomography angiography, and contralateral perfusion of the flap was estimated using intraoperative indocyanine green angiography.
RESULTS: PMB was present in approximately 85% of the cases, arising near the lateral border of the rectus abdominis, branching caudomedially in more than half of the cases, and perforating 2.3 cm laterally and 8.8 cm caudally, on average, from the umbilicus. The average perfusion area of zones II and IV significantly expanded to 96.5% and 74.2%, respectively, when PMB was included in the DIEP flap, and 9 of 22 cases showed contrast extending to the entire zone IV.
CONCLUSIONS: The use of the DIEP flap with PMB is a good option for substantial-volume breast reconstruction. When utilizing PMB, it is important to consider its specific anatomy, location of the main perforator, and pedicle length.
METHODS: This retrospective study was conducted on breast reconstruction using the DIEP flap between May 2020 and July 2023. Data on PMB anatomy were collected from preoperative contrast-enhanced computed tomography angiography, and contralateral perfusion of the flap was estimated using intraoperative indocyanine green angiography.
RESULTS: PMB was present in approximately 85% of the cases, arising near the lateral border of the rectus abdominis, branching caudomedially in more than half of the cases, and perforating 2.3 cm laterally and 8.8 cm caudally, on average, from the umbilicus. The average perfusion area of zones II and IV significantly expanded to 96.5% and 74.2%, respectively, when PMB was included in the DIEP flap, and 9 of 22 cases showed contrast extending to the entire zone IV.
CONCLUSIONS: The use of the DIEP flap with PMB is a good option for substantial-volume breast reconstruction. When utilizing PMB, it is important to consider its specific anatomy, location of the main perforator, and pedicle length.
摘要：
背景：当使用深腹壁下动脉（DIEA）穿支（DIEP）皮瓣进行乳房再造时，包括哈特兰普四区,双蒂DIEP皮瓣被认为是确保稳定灌注所必需的.然而,近端内侧支（PMB），这是DIEA最近的穿孔器，可能使单侧DIEP皮瓣获得足够的灌注成为可能。本研究旨在阐明PMB的详细解剖特征及其在乳房重建中的潜在临床应用。
方法：这项回顾性研究是在2020年5月至2023年7月之间使用DIEP皮瓣进行的乳房重建。PMB解剖数据来自术前对比增强计算机断层扫描血管造影，使用术中吲哚菁绿血管造影估计皮瓣的对侧灌注。
结果：大约85%的病例存在PMB，出现在腹直肌的侧边界附近，在一半以上的病例中尾向分支，横向穿孔2.3厘米，尾部穿孔8.8厘米，平均而言,从脐带。Ⅱ区和Ⅳ区平均灌注面积显著扩大至96.5%和74.2%,分别,当PMB包含在DIEP皮瓣中时，22例中有9例显示对比度延伸到整个IV区。
结论：使用带有PMB的DIEP皮瓣是大量乳房重建的良好选择。使用PMB时，重要的是要考虑其特定的解剖结构，主要射孔器的位置,和椎弓根长度。
方法：这项回顾性研究是在2020年5月至2023年7月之间使用DIEP皮瓣进行的乳房重建。PMB解剖数据来自术前对比增强计算机断层扫描血管造影，使用术中吲哚菁绿血管造影估计皮瓣的对侧灌注。
结果：大约85%的病例存在PMB，出现在腹直肌的侧边界附近，在一半以上的病例中尾向分支，横向穿孔2.3厘米，尾部穿孔8.8厘米，平均而言,从脐带。Ⅱ区和Ⅳ区平均灌注面积显著扩大至96.5%和74.2%,分别,当PMB包含在DIEP皮瓣中时，22例中有9例显示对比度延伸到整个IV区。
结论：使用带有PMB的DIEP皮瓣是大量乳房重建的良好选择。使用PMB时，重要的是要考虑其特定的解剖结构，主要射孔器的位置,和椎弓根长度。
