Anatomische Variabilit?t der Durchblutung am Unterbauch

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• 作者：Prof. Dr. M. Ninkovic ; PD Dr. P. Niclas Broer
• 关键词：Mammaplastik ; Chirurgische Lappen ; Perfusionszonen ; Indozyaningrün ; Entscheidungsfindung ; Mammaplasty ; Surgical flaps ; Perfusion zones ; Indocyanine green ; Decision making
• 刊名：Journal f篓鹿r ?sthetische Chirurgie
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：8
• 期：3
• 页码：137-143
• 全文大小：618 KB
• 参考文献：1.Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69:216PubMed View Article
  2.Holm C, Mayr M, H?fter E, Ninkovic M (2006) Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 117(1):37-3
  3.Reardon C, Ceallaigh S, Sullivan S (2004) An anatomical study of the superficial inferior epigastric vessels in humans. Br J Plast Surg 57:515PubMed View Article
  4.Arnez ZM, Khan U, Pogorelec D, Planinsek F (1999) Breast reconstruction using the free superficial inferior epigastric artery (SIEA) flap. Br J Plast Surg 52:276PubMed View Article
  5.Scheflan M, Dinner MI (1983) The transverse abdominal island flap: part I. Indications, contraindications, results, and complications. Ann Plast Surg 10:24PubMed View Article
  6.Hartrampf CR, Scheflan M, Black PW (1982) Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 69:216PubMed View Article
  7.Healy C, Allen RJ (2014) The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 30(2):121-25PubMed
  8.Taylor GI, Palmer JH (1987) The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 40:113PubMed View Article
  9.Moon HK, Taylor GI (1988) The vascular territory of rectus abdominis musculocutaneous flaps based on the deep superior epigastric system. Plast Reconstr Surg 82:815PubMed View Article
  10.Blondeel PN, Arnstein M, Verstraete K, Depuydt K (2000) Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps. Plast Reconstr Surg 106(6):1295-299
  11.Losken A, Zenn MR, Hammel JA, Walsh MW, Carlson GW (2012) Assessment of zonal perfusion using intraoperative angiography during abdominal flap breast reconstruction. Plast Reconstr Surg 129(4):618e-24ePubMed View Article
  12.Douglas HE, Wilkinson MJ, Mackay IR (2014) Effects of perforator number and location on the total pedicle flow and perfusion of zone IV skin and fat of DIEP flaps. J Plast Reconstr Aesthet Surg 67(2):212-18PubMed View Article
  13.Rahmanian-Schwarz A, Rothenberger J, Hirt B, Luz O, Schaller HE (2011) A combined anatomical and clinical study for quantitative analysis of the microcirculation in the classic perfusion zones of the deep inferior epigastric artery perforator flap. Plast Reconstr Surg 127(2):505-13PubMed View Article
  14.Andree C, Langer S, Seidenstuecker K, Richrath P, Behrendt P, Koeppe T, Hagouan M, Witzel C, Al Benna S, Munder B (2013) A single center prospective study of bilateral breast reconstruction with free abdominal flaps: a critical analyses of 144 patients. Med Sci Monit 19:467-74PubMed Central PubMed View Article
  15.Wolfram D, Schoeller T, Hussl H, Wechselberger G (2006) The superficial inferior epigastric artery (SIEA) flap: indications for breast reconstruction. Ann Plast Surg 57(6):593-96PubMed View Article
  16.Ulusal BG, Cheng MH, Wei FC, Ho-Asjoe M, Song D (2006) Breast reconstruction using the entire transverse abdominal adipocutaneous flap based on unilateral superficial or deep inferior epigastric vessels. Plast Reconstr Surg 117:1395PubMed View Article
  17.Holm C, Mayr M, H?fter E, Ninkovic M (2007) The versatility of the SIEA flap: a clinical assessment of the vascular territory of the superficial epigastric inferior artery. J Plast Reconstr Aesthet Surg 60(8):946-51PubMed View Article
  18.Spiegel AJ, Khan FN (2007) An intraoperative algorithm for use of the SIEA flap for breast reconstruction. Plast Reconstr Surg 120:1450PubMed View Article
  19.Quilichini J, Le Masurier P, Guihard T (2010) Increasing the reliability of SIEA flap using peroperative fluorescent angiography with indocyanine green in breast reconstruction. Ann Chir Plast Esthet 55(6):531-38PubMed View Article
  20.Casey WJ 3rd, Connolly KA, Nanda A, Rebecca AM, Perdikis G, Smith AA (2015) Indocyanine green Laser angiography improves deep inferior epigastric perforator flap outcomes following abdominal suction lipectomy. Plast Reconstr Surg 135(3):491e-97ePubMed View Article
  21.Holm C, Mayr M, H?fter E et al (2008) Interindividual variability of the SIEA angiosome: effects on operative strategies in breast reconstruction. Plast Reconstr Surg 122(6):1612-620
  22.Volpe AG, Rothkopf DM, Walton RL (1994) The versatile superficial inferior epigastric flap for breast reconstruction. Ann Plast Surg 32(2):113-17
  23.Chevray PM (2004) Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAMand DIEP flaps. Plast Reconstr Surg 114(5):1077-083; discussion 1084-085
  
• 作者单位：Prof. Dr. M. Ninkovic (1)
  PD Dr. P. Niclas Broer (1)
  
  1. Abteilung für Plastische, Rekonstruktive, Hand- und Verbrennungschirurgie, Klinikum Bogenhausen, Englschalkingerstr. 77, 81925, München, Deutschland
  
• 刊物主题：Surgery; Head and Neck Surgery; Plastic Surgery; Otorhinolaryngology; Dermatology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1867-4313

文摘

Background The anatomy of the perfusion zones of the lower abdomen provide the foundation for both pedicled transverse rectus abdominus myocutaneous (TRAM) flaps and microvascular-based breast reconstruction. The anatomical context of these techniques was described by Taylor et al. and the clinical context by Hartrampf et al. and therefore established the TRAM, deep inferior epigastric perforator (DIEP) and superficial inferior epigastric artery (SIEA) flap techniques. Objectives The perfusion zones I-IV of the lower abdomen originally described by Hartrampf et al. are still widely accepted as the basis with respect to preoperative and intraoperative planning and decision-making of abdominally based autologous breast reconstruction. The question is whether the classification of these perfusion zones is proven to be clinically and intraoperatively constant and reliable. Furthermore, the question arises how the deep inferior epigastric artery-based perfusion system is linked to the superficial inferior epigastric artery-based system. Methods In a clinical prospective study of 15 patients undergoing DIEP flap breast reconstruction and 25 patients who met the anatomical criteria for SIEA flap surgery, the vascular region of the deep epigastric artery-based system and the contribution of the superficial epigastric artery-based system were visualized intraoperatively using laser-induced fluorescence of indocyanine green. Results Intraoperative in vivo perfusion patterns did not completely correlate with the classical perfusion zones described by Hartrampf et al. Furthermore, the extensive variability of the SIEA-based vascular system could be demonstrated. Conclusion The perfusion zones of the lower abdomen described by Hartrampf et al. should be revised according to the results presented, as the ipsilateral abdominal half has an axial pattern of perfusion and the contralateral half shows a random pattern of perfusion. Laser-induced intraoperative indocyanine green fluorescence measurements provide a valid and indispensable tool when assessing the suitability of flaps based on the superficial epigastric artery. Using this information the reliability of abdominally based autologous breast reconstruction can be further optimized and the invasiveness of the operations can be reduced.