Archives of Hand and Microsurgery

The Korean Society for Surgery of the Hand (대한수부외과학회)
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Classification of Deep Inferior Epigastric Perforator Courses Based on Computed Tomography Angiography: Incidences and Clinical Implications

컴퓨터 단층 촬영 혈관 조영술을 이용한 심하복벽 혈관과 천공지의 박리 용이성에 따른 분류

  • Lee, Yeonhoon (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung Chan (Woori Plastic Surgery Clinic) ;
  • Eom, Jin Sup (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Eun Key (Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 이연훈 (울산대학교 의과대학 서울아산병원 성형외과학교실) ;
  • 김성찬 (우리성형외과의원) ;
  • 엄진섭 (울산대학교 의과대학 서울아산병원 성형외과학교실) ;
  • 김은기 (울산대학교 의과대학 서울아산병원 성형외과학교실)
  • Received : 2018.07.25
  • Accepted : 2018.09.17
  • Published : 2018.12.01
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Abstract

Purpose: Preoperative surgical planning utilizing computed tomography angiography (CTA) has now become a routine in many practices. We analyzed the course of the deep inferior epigastric artery (DIEA) and its perforators (DIEP) that would either facilitate or hinder flap dissection based on CTA to aid surgical planning. Methods: The 115 consecutive patients who underwent abdominally based free flap breast reconstruction were enrolled in this prospective study. DIEA/P courses were categorized mainly according to their intramuscular courses and their incidences were investigated. Results: A total of 425 perforators were identified preoperatively on the CTA, with an average number of 3.7 distinctly visualized in the entire flap territory. Eighty-nine perforators (20.9%) had a favorable (less than 1 cm intramuscular course) pattern, namely long submuscular (34.8% of the patients), long subfascial (15.6%), and total circummuscular (13.9%). Overall 56.5% of the patients had at least one favorable DIEA/P. On the other hand, absence of DIEA and absence of adequate (>1 mm) DIEP was reported in 3 and 8 hemiabdomen. Conclusion: Preoperative CTA evaluation of DIEA/P can be used to identify favorable as well as unfavorable courses for dissection to aid surgical planning.

목적: 우리는 미세혈관 유방 재건술 수술 계획에 참고하기 위하여 컴퓨터 단층 촬영(computed tomography, CT)혈관 조영술을 이용하여 심하복벽혈관과 천공지의 주행을 세부 유형으로 나누어 보고 영상 및 임상 소견의 상관성과 각 유형의 빈도를 보고하고자 한다. 방법: 하복부 조직을 이용한 유방 재건을 받은 연속한 115명의 환자를 전향적으로 분석하였다. 심하복벽동맥과 천공지를 주로 근육 내 주행의 특징에 따라 박리하기 용이한 것과 박리에 곤란한 것으로 특징짓고 각각의 빈도를 조사하였다. 결과: 확인된 425개의 천공지 중 89개(20.9%)의 천공지는 박리에 용이한 주행을 하였으며 긴 근육 아래 주행(34.8%), 긴 근막 아래 주행(15.6%), 근육 주위 주행(13.9%)이 그에 속하였다. 반면 심하복벽동맥이 없거나 적절한 천공지가 조영되지 않는 경우가 3예와 8예에서 보고되었다. 총 65명(56.5%)의 환자가 적어도 한 개 이상의 박리가 용이한 천공지를 가지고 있었다. 결론: 수술 전 CT 혈관 조영술을 통하여 심하복벽동맥과 천공지의 주행을 분석하여 박리에 용이한 유형과 곤란한 유형을 미리 파악함으로써 수술 계획의 수립에 도움을 받을 수 있다.

Keywords

References

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