Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of the second and third intercostal spaces regarding the use of internal mammary vessels as recipient vessels in DIEP flap breast reconstruction: An anatomical and clinical study

  • Seong, Ik Hyun (Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University) ;
  • Woo, Kyong-Je (Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University)
  • Received : 2019.09.20
  • Accepted : 2020.05.25
  • Published : 2020.07.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background The purpose of this study was to compare the anatomical features of the internal mammary vessels (IMVs) at the second and third intercostal spaces (ICSs) with regard to their use as recipient vessels in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods A total of 38 consecutive DIEP breast reconstructions in 36 patients were performed using IMVs as recipient vessels between March 2017 and August 2018. The intraoperative findings and postoperative complications were analyzed. Anatomical analyses were performed using intraoperative measurements and computed tomography (CT) angiographic images. Results CT angiographic analysis revealed the mean diameter of the deep inferior epigastric artery to be 2.42±0.27 mm, while that of the deep inferior epigastric vein was 2.91±0.30 mm. A larger mean vessel diameter was observed at the second than at the third ICS for both the internal mammary artery (2.26±0.32 mm vs. 1.99±0.33 mm, respectively; P=0.001) and the internal mammary vein (IMv) (2.52±0.46 mm vs. 2.05±0.42 mm, respectively; P<0.001). Similarly, the second ICS was wider than the third (18.08±3.72 mm vs. 12.32±2.96 mm, respectively; P<0.001) and the distance from the medial sternal border to the medial IMv was greater (9.49±2.28 mm vs. 7.18±2.13 mm, respectively; P<0.001). Bifurcations of the IMv were found in 18.4% of cases at the second ICS and in 63.2% of cases at the third ICS. Conclusions The IMVs at the second ICS had more favorable anatomic features for use as recipient vessels in DIEP flap breast reconstruction than those at the third ICS.

Keywords

References

  1. Panchal H, Matros E. Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg 2017;140:7S-13S. https://doi.org/10.1097/PRS.0000000000003941
  2. Vollbach FH, Heitmann CD, Fansa H. An appraisal of internal mammary artery perforators as recipient vessels in microvascular breast reconstruction: an analysis of 515 consecutive cases. Plast Reconstr Surg Glob Open 2016;4:e1144. https://doi.org/10.1097/gox.0000000000001144
  3. Haywood RM, Raurell A, Perks AG, et al. Autologous free tissue breast reconstruction using the internal mammary perforators as recipient vessels. Br J Plast Surg 2003;56:689-91. https://doi.org/10.1016/S0007-1226(03)00206-6
  4. Majumder S, Batchelor AG. Internal mammary vessels as recipients for free TRAM breast reconstruction: aesthetic and functional considerations. Br J Plast Surg 1999;52:286-9. https://doi.org/10.1054/bjps.1998.3059
  5. Follmar KE, Prucz RB, Manahan MA, et al. Internal mammary intercostal perforators instead of the true internal mammary vessels as the recipient vessels for breast reconstruction. Plast Reconstr Surg 2011;127:34-40.
  6. Kim H, Lim SY, Pyon JK, et al. Preoperative computed tomographic angiography of both donor and recipient sites for microsurgical breast reconstruction. Plast Reconstr Surg 2012;130:11e-20e. https://doi.org/10.1097/PRS.0b013e3182547d2a
  7. Arnez ZM, Valdatta L, Tyler MP, et al. Anatomy of the internal mammary veins and their use in free TRAM flap breast reconstruction. Br J Plast Surg 1995;48:540-5. https://doi.org/10.1016/0007-1226(95)90041-1
  8. Clark CP 3rd, Rohrich RJ, Copit S, et al. An anatomic study of the internal mammary veins: clinical implications for free-tissue-transfer breast reconstruction. Plast Reconstr Surg 1997;99:400-4. https://doi.org/10.1097/00006534-199702000-00014
  9. Tuinder S, Dikmans R, Schipper RJ, et al. Anatomical evaluation of the internal mammary vessels based on magnetic resonance imaging (MRI). J Plast Reconstr Aesthet Surg 2012;65:1363-7. https://doi.org/10.1016/j.bjps.2012.04.035
  10. Cakir B, Akan M, Akoz T. The management of size discrepancies in microvascular anastomoses. Acta Orthop Traumatol Turc 2003;37:379-85.
  11. Monsivais JJ. Microvascular grafts: effect of diameter discrepancy on patency rates. Microsurgery 1990;11:285-7. https://doi.org/10.1002/micr.1920110407
  12. Harris JR, Seikaly H, Calhoun K, et al. Effect of diameter of microvascular interposition vein grafts on vessel patency and free flap survival in the rat model. J Otolaryngol 1999; 28:152-7.
  13. Sacks JM, Chang DW. Rib-sparing internal mammary vessel harvest for microvascular breast reconstruction in 100 consecutive cases. Plast Reconstr Surg 2009;123:1403-7. https://doi.org/10.1097/PRS.0b013e3181a07249
  14. Tan O, Yuce I, Aydin OE, et al. A radioanatomic study of the internal mammary artery and its perforators using multidetector computed tomography angiography. Microsurgery 2014;34:277-82. https://doi.org/10.1002/micr.22185
  15. Sasaki Y, Madada-Nyakauru RN, Samaras S, et al. The ideal intercostal space for internal mammary vessel exposure during total rib-sparing microvascular breast reconstruction: a critical evaluation. J Plast Reconstr Aesthet Surg 2019;72: 1000-6. https://doi.org/10.1016/j.bjps.2019.01.008
  16. Vanschoonbeek A, Fabre G, Nanhekhan L, et al. Outcome after urgent microvascular revision of free DIEP, SIEA and SGAP flaps for autologous breast reconstruction. J Plast Reconstr Aesthet Surg 2016;69:1598-608. https://doi.org/10.1016/j.bjps.2016.09.017
  17. Broer PN, Weichman KE, Tanna N, et al. Venous coupler size in autologous breast reconstruction: does it matter? Microsurgery 2013;33:514-8. https://doi.org/10.1002/micr.22169
  18. Khoo A, Rosich-Medina A, Woodham A, et al. The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace rib-sparing internal mammary vessel exposure. Microsurgery 2014;34:448-53. https://doi.org/10.1002/micr.22238
  19. Suzuki S, Furui S, Kaminaga T. Accuracy of automated CT angiography measurement of vascular diameter in phantoms: effect of size of display field of view, density of contrast medium, and wall thickness. AJR Am J Roentgenol 2005;184:1940-4. https://doi.org/10.2214/ajr.184.6.01841940
  20. Woo KJ, Park JW, Mun GH. The lateral calcaneal artery as an alternative recipient vessel option for heel and lateral foot reconstruction. Microsurgery 2018;38:164-71. https://doi.org/10.1002/micr.30148