背景:乳内动脉(IMA)是保留皮肤乳房切除术(SSM)后立即进行自体乳房重建中微血管吻合的首选受体血管。尽管IMA约占乳房血液供应的60%,对乳房切除术皮瓣灌注的确切贡献尚不清楚。这项观察性研究的目的是研究使用IMA作为受体血管对吲哚菁绿血管造影(ICGA)评估的内侧乳房切除术皮瓣灌注的影响。
方法:这项观察性研究包括10名在SSM后立即进行自体乳房重建的连续女性。进行了两次术中吲哚菁绿(ICG)评估,以评估内侧乳房切除术皮瓣上部和下部的组织灌注:第一次在SSM之后,第二次在夹紧IMA之后。在120秒的血管造影中,在60、90和120s后制作了三张额外的图像。ICG流入时间和平均值,minimum,并获得最大荧光强度(FI)。
结果:包括四个单侧和六个双侧自体乳房重建。当比较流入时间时,组织灌注没有差异(24.1s与23.0s,P=0.348),平均FI(131.4vs.124.0,P=0.126),最低FI(28.6vs.33.4,P=0.086),和最大FI(253.1vs.247.6,P=0.166)在夹紧IMA之前和之后。
结论:根据这项研究,在接受SSM后立即进行自体乳房重建的患者中,使用IMA作为受体血管不会减少内侧乳房切除皮瓣灌注.
The internal mammary artery (IMA) is the preferred recipient vessel for microvascular anastomosis in immediate autologous breast reconstruction following skin-sparing mastectomy (SSM). Although the IMA accounts for approximately 60% of the blood supply to the breast, the exact contribution to the mastectomy skin flap perfusion is unclear. The aim of this observational
study was to investigate the impact of using the IMA as a recipient vessel on medial mastectomy skin flap perfusion assessed with indocyanine green angiography (ICGA).
This observational
study included ten consecutive women who underwent immediate autologous breast reconstructions following SSM. Two intraoperative indocyanine green (
ICG) assessments were performed to assess tissue perfusion of the upper and lower part of the medial mastectomy skin flap: the first following the SSM and the second after clamping the IMA. During a 120-second angiography, three additional images were made after 60, 90, and 120 s. The
ICG inflow time and mean, minimum, and maximum fluorescence intensities (FIs) were obtained.
Four unilateral and six bilateral autologous breast reconstructions were included. There was no difference in tissue perfusion when comparing the inflow time (24.1 s vs. 23.0 s, P = 0.348), the mean FI (131.4 vs. 124.0, P = 0.126), minimum FI (28.6 vs. 33.4, P = 0.086), and maximum FI (253.1 vs. 247.6, P = 0.166) before and after clamping the IMA.
According to this
study, the use of the IMA as a recipient vessel does not reduce medial mastectomy skin flap perfusion in patients undergoing immediate autologous breast reconstructions following SSM.