The Basic Research Of DIEP Flap Carrying Sensory Nerve Applied In Breast Reconstruction

Objective This study is to observe the course and distribution of inferior epigastric artery(DIEA) and its muscle cutaneous branches, and further to observe the course, distribution and feeling dominated situation of lower intercostal nerves associated with DIEP flap through anatomical entities of DIEP flaps, while to investigate whether lower abdominal transverse incision scars and the number of lower abdominal transverse incision can have any impact on the number and location of abdominal blood vessels and perforating vessels through imaging studies.Methods Specimens for ten Chinese female adult corpses(From the basic medical college of hebei university of joint anatomy teaching and research section.)by 10% formaldehyde solution fixed,Body average age is(44.4±7.2) years old., bilateral inferior epigastric artery and vein were perfused latex, dissected after latex is cured, then observe the course and distribution of inferior epigastric artery(DIEA) and its muscle cutaneous branches, and further to observe the course, distribution and feeling dominated situation of lower intercostal nerves associated with DIEP flap, the resulting data were statistically analyzed; 300 cases female patient treated in three Affiliated Hospital of North China University of Technology between June, 2012 – December, 2014, average age is(34.4±7.2) years old. According to whether the transverse incision cesarean surgery, divided into study group(history of cesarean section surgery) that selected from 610 cases and control group(no cesarean surgery)that selected randomly from 610, per 50 cases. All objects were scanned by CTA 64-slice CT to detect number and location of abdominal perforator blood vessels, the resulting data were statistically analyzed.Results DIEP flap dissection research results: 1) above 16 side DIEA after inguinal ligament from external iliac artery(80%), 4 lateral DIEA from femoral artery(20%). The diameter of DIEA starting point was(2.2±0.2) mm, the diameter to the rectus muscle(1.5±0.3) mm; DIEA is divided into three type: type 1(5/20), 2(13/20), and 3(2/20), in the second type of team, lateral branch for advantage branch of 7 cases of medial branch of advantage branch in 6 cases, two cases of three type, the lateral branches are advantages. 2) each DIEA have two accompanying vein, the inside diameter is(3.0±0.8) mm, and outer diameter is(1.5±0.3) mm. 3) 20 side had 124 DIEA perforators with 0.5 mm diameter, each side(6.4±1.5) mm, the distance in fascia contorts was(21.2±9.6) mm and diameter was 0.8±0.3 mm, the area of each perforators anatomy was(30.8±5.5). Most DIEP(75.0%) in periumbilical area, inside than the outside(45.0% vs. 29.9%). 4) the number of T10 nerve was 2 ~ 5(3.4 ±1.2 mm), T11 for 1 ~ 6(4.2±1.5) and T12 for 1 ~ 5(2.3±1.2). T10, T11, lateral from T12 feeling branch is a more, and the inside of the feeling is different, T10 is 2 ~ 3, T11 and T12 is 1 ~ 2. Sensory branch of intercostals nerve pedicle length(27.3±12.5) mm(5~81), its distribution is consistent with the corresponding vascular perforators, but in the DIEP intercostals nerve with sensory branch line only accounted for 44.3%(98/221), of which about 79%(98/124) in the bulky DIEP with intercostals nerve sensory branch line, and only 36.1%(35/97) in small DIEP with feel branch line. 2 DIEP radiographic results:1) The mean number of perforator vessels was 10.61 in the study group and 11.41 in the control group, which was not statistically different. 2) The mean number of perforator vessels in four areas of lower abdomen was no significant differences between study and control groups. 3) With more the time of Cesarean section, more number of perforator vessels.Conclusions 1 Near the umbilical region of the lateral bulky to wear off line clear and little damage to the muscle tissue, and more with intercostals nerve sensation, is an ideal area for making DIEP flap. 2 DIEP flap blood is supplied by l~3 blood vessels, its vascular pedicle is longer, and the blood supply is abundant, sufficient amount of tissue flaps meet the needs of the majority of women breast reconstruction. The DIEP flap don’t carry the rectus organization and motor nerve, but carry the relevant sensory nerve in the process of preparation, on the one hand, it can avoid the donor muscle nerve atrophy, on the other hand, DIEP flap carrying sensory nerve that makes it possible to breast sensation function reconstruction. 3 Lower abdominal transverse incision scars and the number of lower abdominal transverse incision can have no impact on the number and location of abdominal blood vessels and perforating vessels, Speculated that it might cause a process of ischemic preconditioning after abdominal postoperative, and in the process,it will happen vascular remodeling, perforators continue to grow in order to compensate the damaged blood vessels microcirculation.