Breast reconstruction with pedicled perforator flaps / 中国癌症杂志

Comparing with free perforator flap, pedicled flap is a relatively simpler and safer technique, with lesser donor site morbidity. In recent years, the application of pedicled perforator flaps has emerged as a new option for breast reconstruction. Those pedicled perforator flaps include thoracodorsal artery perforator flap, intercostal artery perforator flap (lateral intercostal artery perforator flap, anterior intercostal perforator flap) etc. Serratus anterior artery perforator flap, superior epigastric artery perforator flap, and lateral thoracic artery perforator flap can also be raised technically. To enhance surgical accuracy, it is necessary to evaluate the location and quality of perforator vessels preoperatively. Proper flap design is of more importance for pedicled flap when compared with it's free flap counterpart. Although free flap approach remains the golden standard in breast reconstruction when considering autologous tissue transplantation, pedicled perforator flap has the apparent merits of minimized surgical trauma, less time-consuming and less stress for reconstructive surgeons.

Spiral CT localization of the point where superior epigastric artery perforates rectus abdominis muscle / 中华医学美学美容杂志

Objective To locate the points where the superior epigastric artery perforates the rectus abdominis muscle by using the spiral CT,in order to evaluate its control on abdominal complications after breast reconstruction.Methods Fifty cases had received abdominal spiral CT angiography,respectively.Then the coordinate system was established,with the umbilicus as the origin,the umbilicus horizontal line as X axis,vertical umbilical level line as Y axis.The point where superior epigastric artery perforates the rectus abdominis muscle in the coordinate system was located as described above.Results There were 392 perforating points in the rectus abdominis muscle in all 50 cases,with a mean of 7.84 perforators per patient.In the first quadrant,the points where superior epigastric artery perforate the rectus abdominis muscle were located in the range from 1.45 cm to 5.47 cm on the X axis,and in the range from 2.52 cm to 16.38 cm on the Y axis,respectively.In the second quadrant,the points where superior epigastric artery perforates the rectus abdominis muscle were located in the range from 2.02 cm to 6.80 cm on the X axis,and in the range from 2.30 cm to 14.46 cm on the Y axis,respectively.Conclusions The spiral CT angiography has high sensitivity and specificity,it can locate the point where the superior epigastric artery perforates the rectus abdominis muscle,which can avoid to cut extra rectus abdominis muscle.It is significant to reach best postoperative effect with the lowest donor site complications.

Morphologic Study of the Rectus Abdominis Muscle for Flap Surgery / 체질인류학회지

Forty-nine cadaver dissections (male 30, female 19) were performed to identify the shape and size of rectus abdominis muscle and the distribution of vessels in Korean for flap surgery. The total length between xiphoid process and pubic symphysis of male is 375.9+/-41.8 mm and female is 339.4+/-39.1 mm. But the length between umbilicus and pubic symphysis of male and female did not show significant difference. The three tendinous intersections are 61.2%, the 4 intersections are 35.7%, and 2 intersections are 3.1%. The most of first, second and third intersections had the most complete intersection. The most of fourth intersection had the most fragmentary intersection. The external diameter of superior epigastric artery is 1.4+/-0.3 mm, and inferior epigastric artery is 2.6+/-0.6 mm. The percentage of superior epigastric artery that goes into the medial 1/3 region of rectus abdominis muscle is 52%, middle 1/3 region is 38%, lateral 1/3 region is 2% and 2 stem goes into the muscle is 8%. The length between the origin of inferior epigastric artery and the point of semilunar line met inferior epigastric artery is 41.1 mm in male and 38.8 mm in female.