Routine use of microvascular coupling device for arterial anastomosis in breast reconstruction
Routine use of microvascular coupling device for arterial anastomosis in breast reconstruction
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DOI：
10.1097/01.sap.0000202614.45743.34
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发表时间：
2006-04-01
影响因子：
1.5
通讯作者：
Ahn, CY
中科院分区：
文献类型：
--
作者：
Spector, JA;Draper, LB;Ahn, CY
背景资料：尽管微血管耦合装置常规且成功地用于静脉吻合，但很少有已发表的报告证明其用于进行动脉吻合的有效性。这是资深作者（C.Y.A.）方法：回顾性分析了1998年至2004年在纽约大学医学中心由资深作者进行的所有显微外科乳房重建术。结果：60例患者中，保留肌肉的TRAM皮瓣47例，腹壁下动脉穿支皮瓣22例，臀上级皮瓣11例。以腹壁下深动脉为蒂的69例皮瓣中60例（87%）和11例臀肌皮瓣中2例（18%）成功进行了动脉偶联;以胸背动脉为受体血管的74例皮瓣中62例（83.9%）成功进行了动脉偶联，以乳内动脉为受体血管的皮瓣从未进行过动脉偶联。结论：在我们的大型系列中，我们能够在近80%的病例中进行耦合动脉吻合，而没有任何皮瓣丢失。通过适当的血管选择和使用微血管耦合器的足够经验，可以以快速、安全和可靠的方式进行动脉耦合，发病率最低。尽管不常实践，但使用用于动脉吻合的耦合装置可提供显著的时间节省，尤其是在双侧乳房重建中。
Background: Although microvascular coupling devices are used routinely and successfully for venous anastomosis, there are few published reports demonstrating their efficacy for performing arterial anastomosis. It has been the senior author's (C.Y.A.) preference to perform arterial anastomosis using the microvascular coupling device when feasible.Methods: All microsurgical breast reconstructions performed by the senior author at the New York University Medical Center between 1998 and 2004 were retrospectively reviewed. A total of 60 patients underwent microsurgical breast reconstruction, of which 20 were bilateral, for a total of 80 flaps.Results: Of the 80 flaps performed, there were 47 muscle-sparing TRAM and 22 deep inferior epigastric perforator (DIEP) flaps, and I I were superior gluteal flaps. Arterial coupling was successfully performed in 60 of 69 flaps based on the deep inferior epigastric artery (87%) and 2 of 11 gluteal flaps (18%); arterial coupling was performed successfully 62 of 74 times (83.9%) when the thoracodorsal artery was the recipient vessel and never performed when the internal mammary artery was the recipient vessel. The overall flap success rate was 100%.Conclusions: In our large series, we were able to perform a coupled arterial anastomosis in nearly 80% of the cases, without the loss of any flaps. With proper vessel selection and sufficient experience using the microvascular coupler, arterial coupling may be performed in an expeditious, safe, and reliable fashion with minimal morbidity. Though not commonly practiced, use of the coupling device for arterial anastomosis can provide significant time savings, especially in bilateral breast reconstructions.