Role of intercostal neurovascular perforator in lower abdominal flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHANG Yixin ² , ZHOU Bo ¹ , LÜ Chunliu ¹ , TANG Yuanyuan ¹ , YI Liang ¹ , LUO Zhenhua ¹

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P. R. China;
2. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P. R. China;

Corresponding author：

LI Zan, Email: zzanli@163.com

Keywords：

Intercostal neurovascular perforator; inferior epigastric artery perforator flap; breast reconstruction

DOI：

10.7507/1002-1892.202201098

Video：

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Objective To investigate if intercostal neurovascular perforator can nourish lower abdominal flap. Methods Between June 2017 and December 2020, in 39 female patients with predominant perforator originated from intercostal nerve nutrient vessels, main trunk of the deep inferior epigastric vessels was chosen to be the pedicle to harvest free lower abdominal flap for breast reconstruction. The age of the patients ranged from 28 to 52 years, with an average of 38.6 years. There were 16 cases on the left and 23 cases on the right. The duration of breast cancer was 3-32 months, with an average of 21.8 months. Pathological stage was stageⅡin 31 cases and stage Ⅲ in 8 cases. Among them, 25 cases were primary tumor resection and one stage breast reconstruction and 14 cases were delayed breast reconstruction. Results The lower abdominal flap pedicled with one side pedicle was harvested in 32 cases, all of which were supplied by the main trunk of the deep inferior epigastric vessel combined with the intercostal neurovascular perforator; 7 cases were harvested with bilateral pedicled lower abdominal flaps, of which 4 cases were supplied by the main trunk of the deep inferior epigastric vessel combined with intercostal neurovascular perforator on one side and deep inferior epigastric artery perforator on the other side, and the other 3 cases were supplied by bilateral main trunk of the deep inferior epigastric vessel and the intercostal neurovascular perforator. In the flaps nourished with the main trunk of the deep inferior epigastric vessel combined with the intercostal neurovascular perforator, the intercostal neurovascular perforators were one branch type in 15 cases, one branch+reticular type in 19 sides, and reticular type in 8 sides. The size of flap ranged from 26 cm×10 cm to 31 cm×13 cm; the thickness was 2.5-5.5 cm (mean, 2.9 cm); the vascular pedicle length was 7.0-11.5 cm (mean, 9.2 cm); the weight of the flap was 350-420 g (mean, 390 g). All the flaps survived completely and the incisions at donor sites healed by first intention. All patients were followed up 14-35 months (mean, 25.4 months). The shape, texture, and elasticity of reconstructed breasts were good and no flap contracture happened. Only linear scar left at the donor site, the function of abdomen was not affected. No local recurrence happened. Conclusion When the direct perforator of the deep inferior epigastric artery may not provide reliable blood supply for the lower abdominal flap, the intercostal neurovascular perforator with deep inferior epigastric vessels can ensure the blood supply of the free lower abdominal flap.

Citation： SONG Dajiang, LI Zan, ZHANG Yixin, ZHOU Bo, LÜ Chunliu, TANG Yuanyuan, YI Liang, LUO Zhenhua. Role of intercostal neurovascular perforator in lower abdominal flap. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 770-775. doi: 10.7507/1002-1892.202201098 Copy

1.	Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg, 1994, 32(1): 32-38.
2.	Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
3.	宋达疆, 李赞, 周晓, 等. 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. 中国修复重建外科杂志, 2021, 35(5): 605-610.
4.	宋达疆, 李赞, 章一新, 等. 带蒂腹直肌肌皮瓣联合游离腹壁下动脉穿支皮瓣及携带髂腹股沟淋巴组织瓣行乳腺癌根治术后乳房再造及上肢淋巴水肿治疗的效果. 中华烧伤杂志, 2020, 36(4): 297-303.
5.	宋达疆, 刘德权, 李赞, 等. 游离腹壁下动脉穿支皮瓣在双侧乳房再造中的应用. 中华整形外科杂志, 2019, 35(9): 892-897.
6.	宋达疆, 李赞, 周晓, 等. 不同形式横行腹直肌肌皮瓣在乳房再造和胸壁溃疡修复中的应用经验教训及对策. 中国医师杂志, 2018, 20(4): 511-516.
7.	Park JE, Chang DW. Advances and innovations in microsurgery. Plast Reconstr Surg, 2016, 138(5): 915e-924e.
8.	张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
9.	Masia J, Kosutic D, Clavero JA, et al. Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction. J Reconstr Microsurg, 2010, 26(1): 21-28.
10.	Masia J, Clavero JA, Larrañaga JR, et al. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg, 2006, 59(6): 594-599.
11.	Mun GH, Kim HJ, Cha MK, et al. Impact of perforator mapping using multidetector-row computed tomographic angiography on free thoracodorsal artery perforator flap transfer. Plast Reconstr Surg, 2008, 122(4): 1079-1088.
12.	Hsieh F, Kumiponjera D, Malata CM. An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars-results from a single surgeon’s experience. J Plast Reconstr Aesthet Surg, 2009, 62(12): 1650-1660.

1. Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction. Ann Plast Surg, 1994, 32(1): 32-38.
2. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg, 1989, 42(6): 645-648.
3. 宋达疆, 李赞, 周晓, 等. 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. 中国修复重建外科杂志, 2021, 35(5): 605-610.
4. 宋达疆, 李赞, 章一新, 等. 带蒂腹直肌肌皮瓣联合游离腹壁下动脉穿支皮瓣及携带髂腹股沟淋巴组织瓣行乳腺癌根治术后乳房再造及上肢淋巴水肿治疗的效果. 中华烧伤杂志, 2020, 36(4): 297-303.
5. 宋达疆, 刘德权, 李赞, 等. 游离腹壁下动脉穿支皮瓣在双侧乳房再造中的应用. 中华整形外科杂志, 2019, 35(9): 892-897.
6. 宋达疆, 李赞, 周晓, 等. 不同形式横行腹直肌肌皮瓣在乳房再造和胸壁溃疡修复中的应用经验教训及对策. 中国医师杂志, 2018, 20(4): 511-516.
7. Park JE, Chang DW. Advances and innovations in microsurgery. Plast Reconstr Surg, 2016, 138(5): 915e-924e.
8. 张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
9. Masia J, Kosutic D, Clavero JA, et al. Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction. J Reconstr Microsurg, 2010, 26(1): 21-28.
10. Masia J, Clavero JA, Larrañaga JR, et al. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J Plast Reconstr Aesthet Surg, 2006, 59(6): 594-599.
11. Mun GH, Kim HJ, Cha MK, et al. Impact of perforator mapping using multidetector-row computed tomographic angiography on free thoracodorsal artery perforator flap transfer. Plast Reconstr Surg, 2008, 122(4): 1079-1088.
12. Hsieh F, Kumiponjera D, Malata CM. An algorithmic approach to abdominal flap breast reconstruction in patients with pre-existing scars-results from a single surgeon’s experience. J Plast Reconstr Aesthet Surg, 2009, 62(12): 1650-1660.

Chinese Journal of Reparative and Reconstructive Surgery

Role of intercostal neurovascular perforator in lower abdominal flap

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