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. 2021 May 15;35(5):605-610.
doi: 10.7507/1002-1892.202011020.

[Muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction]

[Article in Chinese]
Dajiang Song  1 , Zan Li  1 , Xiao Zhou  1 , Yixin Zhang  2 , Guang Feng  3 , Bo Zhou  1 , Chunliu Lü  1 , Peng Wu  1 , Yuanyuan Tang  1 , Liang Yi  1 , Zhenhua Luo  1
Affiliations

[Muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction]

[Article in Chinese]
Dajiang Song et al. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. .

Abstract
in English, Chinese

Objective: To explore the surgical technique, effectiveness, and safety of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction.

Methods: Between December 2016 and February 2019, 6 cases of early breast cancer received modified radical surgery, lower abdominal flap was applied for one- or two-staged breast reconstruction. The average age of the patients was 34.6 years (range, 29-56 years). The disease duration ranged from 2 to 16 months, with an average of 9.5 months. The tumor was located in the upper outer quadrant in 4 cases and the lower outer quadrant in 2 cases. Pathological examination showed that they were all invasive ductal carcinoma. Four cases of breast cancer were in stage Ⅰ and 2 cases was in stage Ⅱ. During operation, the inferior epigastric artery perforators were found to be close to the upper edge of the flap and/or near the umbilical cord in 4 cases, the inferior epigastric artery perforator vessels were relatively small (<0.3 mm) in 2 cases; and the breast was reconstructed with muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator. The length, width, and thickness of the flap were (28.9±0.2), (12.1±0.4), and (4.4±0.3) cm, respectively. The length of the vascular pedicle was (11.5±0.2) cm and the weight of the flap was (420.5±32.7) g.

Results: All 6 muscle-sparing rectus abdominis myocutaneous flaps were successful, and the breast incisions healed by first intention. There was no vascular crisis, donor site effusion, hematoma, or infection. All 6 patients were followed up 12-36 months (mean, 26.8 months). The reconstructed breast had a good shape, good elasticity, and no flap contracture or deformation; only linear scars left at the donor site of the flap, and the abdominal wall function was not affected. During follow-up, there was no breast cancer recurrence and metastasis.

Conclusion: When the inferior epigastric artery perforators are too close to the upper edge of the flap and/or near the umbilical cord, the vascularity of lower abdominal flap can be ruined, harvested in form of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator can efficiently ensure blood supply safety.

目的: 探讨同时携带肋间动脉穿支与腹壁下动脉穿支保留部分腹直肌的游离腹直肌皮瓣再造乳房的技术、疗效及安全性。.

方法: 2016 年 12 月—2019 年 2 月，对 6 例早期乳腺癌患者行改良根治术同期或二期应用游离腹直肌皮瓣移植再造乳房。患者年龄 29～56 岁，平均 34.6 岁。病程 2～16 个月，平均 9.5 个月。肿瘤位于外上象限 4 例，外下象限 2 例。病理检查示均为浸润性导管癌。乳腺癌分期：Ⅰ期 4 例，Ⅱ期 2 例。术中发现 4 例腹壁下动脉穿支血管位置靠近皮瓣边缘和脐旁，2 例腹壁下动脉穿支血管较为细小（<0.3 mm），以腹壁下动脉穿支联合肋间动脉穿支制备保留部分腹直肌的游离腹直肌皮瓣移植修复。皮瓣长（28.9±0.2）cm、宽（12.1±0.4）cm、厚（4.4±0.3）cm，血管蒂长（11.5±0.2）cm，皮瓣质量（420.5±32.7）g。.

结果: 术后 6 例皮瓣完全成活，乳房切口均Ⅰ期愈合，无血管危象、供区积液、血肿、感染等情况发生。6 例患者均获随访，随访时间 12～36 个月，平均 26.8 个月。再造乳房外形可，弹性好，无皮瓣挛缩变形；皮瓣供区仅遗留线性瘢痕，腹壁功能无影响。随访期间未出现乳腺癌复发转移。.

结论: 腹壁下动脉穿支血管位置靠近皮瓣边缘和脐旁或者过于细小会影响下腹部皮瓣血运，采用腹壁下动脉穿支联合肋间动脉穿支制备保留部分腹直肌的游离腹直肌皮瓣，可有效保证下腹部游离皮瓣的血运。.

Keywords: Inferior epigastric artery perforator; breast reconstruction; free flap; intercostal artery perforator.

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Conflict of interest statement

利益冲突：所有作者声明，在课题研究和文章撰写过程中不存在利益冲突。基金项目经费支持没有影响文章观点和对研究数据客观结果的统计分析及其报道。

Figures

图 1
图 1
Vascular anastomosis of intercostal neurovascular with deep inferior epigastric artery and sended the cutaneous perforator 肋间神经营养血管与腹壁下动脉吻合并发出皮穿支1：肋间动脉神经分支　2：腹壁下动脉穿支　3：肋间动脉穿支　4：肌内交通支　5：腹壁下动脉　6：腹直肌　a. 示意图显示腹壁下动脉发出穿支，腹壁下动脉通过肌内交通支与肋间动脉穿支相交通；b. 术中解剖示肋间动脉穿支与肋间动脉神经分支伴行，与腹壁下动脉吻合
图 2
图 2
Flap harvestion 皮瓣切取
图 3
图 3
A typical case 典型病例
See this image and copyright information in PMC

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