Proximal and distal ends of thoracodosal artery and vein as recipient vessels for immediate breast reconstructions using deep inferior epigastric perforator flap in four cases
10.3760/cma.j.cn114453-20231028-00150
- VernacularTitle:胸背动静脉远近心端为受区血管的腹壁下动脉穿支皮瓣即刻乳房再造术4例
- Author:
Xiuxiu CHEN
1
;
Huangfu WU
;
Lan MU
;
Wuping ZHENG
;
Junbo PAN
;
Guisheng HE
;
Tao SONG
;
Yazhen ZHANG
;
Hengyu CHEN
;
Jinghui HUANG
;
Yilian XU
Author Information
1. 海南医学院第二附属医院乳甲外科，海口 570000
- Keywords:
Breast neoplasms;
Deep inferior epigastric artery perforator flap;
Immediate breast reconstruction;
Thoracodorsal artery;
Thoracodorsal vein
- From:
Chinese Journal of Plastic Surgery
2024;40(5):507-513
- CountryChina
- Language:Chinese
-
Abstract:
Objective:Explore the feasibility and advantages of using proximal and distal ends of thoracodosal artery and vein as recipient vessels in deep inferior epigastric perforator flap immediate breast reconstruction.Methods:The clinical data of patients who underwent breast reconstruction surgery using the proximal and distal ends of the thoracodorsal vein as recipient vessels at the Department of Breast and Thyroid Surgery of the Second Affiliated Hospital of Hainan Medical University from March 2022 to June 2023 were analyzed retrospectively. Preoperative examinations included thoracoabdominal angiography and color Doppler ultrasonic localization of the main trunk and perforators of the inferior epigastric vessels. The procedure began with mastectomy and axillary lymph node dissection, followed by the isolation of bilateral perforators and the main trunk of the abdominal flap. The main trunks of the bilateral inferior epigastric arteries were then transected, and their vascular pedicles exposed and anastomosed respectively to the proximal and distal ends of the thoracodorsal artery and vein. Both arteries and veins were joined end-to-end. The flap after trimming and reconstruction was then implanted into the cavity left after mastectomy through the incision. Breast positioning was performed with the patient in a knee-bent and hip-flexed position. After adjusting the shape of the reconstructed breast. The donor site was closed, the umbilicus was reconstructed, drainage tubes were placed, and the breast incision was closed. Postoperative follow-up monitored complications associated with the flap and patient satisfaction with the breast reconstruction, utilizing a self-assessment method.Results:Four female patients were included, aged (46.0±6.5) years, ranging from 37 to 52 years. All four patients had bilateral vascular pedicles in the donor area, with three patients having thoracodorsal vessels at the distal and proximal ends as recipient vessels, and one patient having anterior serratus branch of the thoracodorsal vessels at the distal and proximal ends. All drainage tubes were removed within 7 to 10 days after surgery. Patients were discharged. Follow-up period ranged from 1 to 15 months, averaging 6 months. The patients recovered well postoperatively, with no flap-related complications occurring. All four patients were satisfied with the result of the reconstruction.Conclusion:The simultaneous application of the proximal and distal ends of the thoracodorsal artery and vein can ensure the safety of flap survival while reducing damage to the ribs and intercostal muscles, achieving better aesthetic result.
