Perforasomes of the DIEP Flap: Vascular Anatomy of the Lateral versus Medial Row Perforators and Clinical Implications
Perforasomes of the DIEP Flap: Vascular Anatomy of the Lateral versus Medial Row Perforators and Clinical Implications
复制标题
DOI：
10.1097/prs.0b013e3181cb63e0
复制
发表时间：
2010-03-01
影响因子：
3.6
通讯作者：
Rohrich, Rod J.
中科院分区：
文献类型：
--
作者：
Wong, Corrine;Saint-Cyr, Michel;Rohrich, Rod J.
背景资料：关于深腹壁下穿支（DIEP）皮瓣的灌注，霍尔姆等人证明了经典的Hartrampf II区和III区可使用荧光灌注技术逆转，这意味着来自蒂的血流在穿过中线之前行进到同侧。作者的假设是，灌注区和血管解剖之间的外侧排和内侧排perforators.Methods之间有很大的差异：三维和四维CT血管造影来重新评价的血管分布区。本研究模拟了36个DIEP皮瓣（14个外侧排穿支血管与22个内侧排穿支血管）。个别穿支血管注射造影剂，每个皮瓣进行动态计算机断层扫描。使用TeraRecon软件查看图像，分析分支模式和灌注flow.Results：注射造影剂的内侧穿支DIEP皮瓣的平均血管面积为296 cm（2），而外侧穿支DIEP皮瓣的平均血管面积为196 cm 2。与外侧交通支相比，内侧交通支的II区灌注更大。与内侧交通支相比，III区外侧交通支的灌注更大。作者发现内侧穿支符合Hartrampf灌注区，外侧穿支符合霍尔姆灌注理论（对于外侧穿支DIEP皮瓣，II区和III区应颠倒）。注射侧行为基础的穿支皮瓣给了一个血管的领土，很少越过midline.Conclusion：内侧和外侧行穿支提供不同的和刻板的区域灌注皮瓣设计和收获有显着的影响。（Plast。重建125：772，2010）。
Background: Regarding the perfusion of a deep inferior epigastric perforator (DIEP) flap, the classic Hartrampf zones II and III were demonstrated by Holm et al. to be reversed using fluorescent perfusion techniques, implying that blood flow from the pedicle travels to the ipsilateral side before crossing the midline. The authors' hypothesis is that the zones of perfusion and the vascular anatomy differ greatly between lateral row and medial row perforators.Methods: Three-dimensional and four-dimensional computed tomographic angiography was utilized to reappraise the zones of vascularity. Thirty-six DIEP flaps were simulated for this study (14 lateral row perforators versus 22 medial row perforators). Individual perforators were injected with contrast and each flap was subjected to dynamic computed tomography scanning. Images were viewed using TeraRecon software, allowing analysis of branching patterns and perfusion flow.Results: The mean vascular territory for a medial perforator DIEP flap injected with contrast was 296 cm(2), compared with 196 cm2 for a lateral perforator DIEP flap. Zone II perfusion was greater in a medial perforator compared with a lateral perforator. Zone III had greater perfusion in a lateral perforator compared with a medial perforator. The authors found that medial perforators conform to the Hartrampf zones of perfusion and lateral perforators follow the Holm theory of perfusion (zones II and III should be reversed for lateral perforator DIEP flaps). Injection of a lateral row-based perforator flap gave a vascular territory that rarely crossed the midline.Conclusion: Medial and lateral row perforators offer distinct and stereotypical zones of perfusion that have a significant effect on flap design and harvesting. (Plast. Reconstr. Surg. 125: 772, 2010.)