背景:上腹下浅动脉(SIEA)的直径和供体与受体动脉在直径方面的匹配程度是影响SIEA皮瓣乳房重建手术结果的关键因素。SIEA的直径≥1.5mm并且供体和受体动脉的直径的匹配度≥1:2(50%)是SIEA和乳内动脉(IMA)实现端对端吻合的公认标准。然而,进一步完善的人口特征和理想的显微吻合肋间平面目前缺乏标准。
方法:在本研究中,基于20侧半腹部的计算机断层扫描血管造影(CTA)数据表明存在SIEA,我们分析了供体和受体动脉的直径及其匹配程度。评估上述参数与体重指数(BMI)之间的相关性。根据匹配度的95%置信区间的下界和50%和67%的两个关键节点,我们从理论上评估了SIEA和IMA在不同水平的BMI和肋间空间的端到端吻合的可能性,并预测了SIEA可能的术中管理措施。
结果:SIEA直径,胸背动脉(TDA)直径,第2至第5肋间水平IMA的直径与BMI呈正相关(p<0.05)。BMI≥24kg/m2的值可以间接反映SIEA直径≥1.5mm的应用前提。SIEA与TDA或IMA在第2至第5肋间水平的匹配程度与BMI呈线性正相关(p<0.001)。基于置信区间分析,我们预测了SIEA在不同BMI水平下可能需要的不同管理技术,当SIEA和IMA或TDA以端到端的方式吻合时。
结论:对于术前CTA数据表明在第二阶段乳房重建中存在SIEA的患者,当满足BMI≥24kg/m2时,理论上,SIEA和IMA可以在第3到第5肋间水平实现端到端吻合,当24kg/m2≤BMI≤25kg/m2时,由于直径差异较大,第二肋间水平的SIEA和IMA可能需要采用端侧吻合术或切换至TDA受体部位.基于本研究的发现和美学效果的考虑,我们认为第三和第四肋间平面是端到端吻合的理想选择。作为打捞接受者的选择,在BMI≥24g/m2的情况下,TDA理论上可以与SIEA实现端到端吻合.
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The superficial inferior epigastric artery (SIEA) diameter and the matching degree between the donor and the recipient arteries in terms of diameter are key factors affecting the outcome of the procedure in breast reconstructions with the SIEA flaps. A diameter of the SIEA ≥ 1.5 mm and a matching degree ≥ 1:2 (50%) of the diameters of the donor and the recipient arteries are recognized standards for the SIEA and the internal mammary artery (IMA) to achieve an end-to-end anastomosis. However, further refinements of the population characteristics and the ideal microscopic anastomosis intercostal planes are currently lacking for the criteria.
In this study, based on 20 sides of hemiabdomen with computed tomography angiography (CTA) data suggesting the presence of the SIEA, we analysed the diameters of the donor and the recipient arteries as well as their matching degrees. The correlations between the parameters above and body mass index (BMI) were assessed. Based on the lower bounds of the 95% confidence intervals of the matching degrees and the two critical nodes of 50% and 67%, we theoretically evaluated the possibility of an end-to-end anastomosis of the SIEA and the IMA at different levels of BMIs and intercostal spaces, and predicted the possible intraoperative management measures for the SIEA.
The SIEA diameter, the thoracodorsal artery (TDA) diameter, and the diameters of the IMA at the 2nd to the 5th intercostal levels were positively correlated with the BMI (p < 0.05). A value of BMI ≥ 24 kg/m2 could indirectly reflect the application premise of the diameter of the SIEA ≥ 1.5 mm. The matching degrees of the SIEA with the TDA or the IMA at the 2nd to the 5th intercostal level were linearly and positively correlated with the BMI (p < 0.001). Based on the confidence interval analysis, we predicted different management techniques that might be needed intraoperatively for the SIEA at different BMI levels, when the SIEA and the IMA or the TDA were to be anastomosed in an end-to-end way.
For patients with preoperative CTA data suggesting the presence of the SIEA in the second-stage breast reconstructions, when a value of BMI ≥ 24 kg/m2 is met, the SIEA and the IMA can theoretically achieve an end-to-end anastomosis at the 3rd to the 5th intercostal level, and when 24 kg/m2 ≤ BMI ≤ 25 kg/m2, due to the large difference in diameters, the SIEA and the IMA at the 2nd intercostal level might need to adopt an end-to-side anastomosis or switch to the TDA recipient site. Based on this study\'s findings and aesthetic effect considerations, we think that the 3rd and the 4th intercostal planes are ideal choices for the end-to-end anastomosis. As a salvage recipient option, the TDA can theoretically achieve an end-to-end anastomosis with the SIEA at a value of BMI ≥ 24 g/m2.
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