| PurposeThe treatment of limb lymphedema which is related with breast cancer remains a challenging task. Although physical therapy can reduce the risk of lymphedema, it can’t solve the problem radically. However, we have made some progress in surgical methods.The groin lymph node flap (L.N flap) has been successfully used to treat lymphedema.The flap is based on superficial circumflex iliac artery/vein(SCIA/V) or superficial inferior epigastric artery/vein(SIEA/V). However, the distribution of lymph nodes(LNs) around those vessels are unknown,which has limited its widespread use. The purpose of this study is to delineate the distribution of lymph nodes in the groin and their relationship to inguinal vessels by the use of multidirector-row CT angiography (MDCTA),lastly to let surgeons design the flap reasonably.Methods1. MDCTA was performed in52patients who underwent the lower abdominal flaps for breast reconstruction. The MDCTA data were used to analyze the locations of lymph nodes and their adjacent vascular vessels. The groin region was divided into the superior lateral (â…¡), superior medial (â…¡), inferior lateral (â…¢), and inferior medial (IV) quadrants based on the point where SCIV joined into great saphenous vein. The number of lymph nodes in each of the four quadrants was counted and the dominant vessels were observed.2. The author analyzed MDCTA data of52patients retrospectively and tried to categorize the anatomic variations among the superficial/deep branch of superficial circumflex iliac artery(S/Db-SCIA) and superficial inferior epigastric artery(SIEA).The anatomic study was completed on four fresh cadavers.In clinical cases,we tried to plan the lower abdominal flap combined with L.N flap by MDCTA.Results1. The mean number of lymph nodes in quadrants I to IV were3.3â'ˆ1.6,2.0±1.2,1.5±1.3and1.9±1.4respectively. The difference between the four quadrants was statistically significant (P<0.001). In quadrant I, the appearance rate of SCIA was100%while SIEA was6.6%. In quadrant II, no SCIA was observed but the appearance rate of SIEA was78.0%. There were neither SCIA nor SIEA observed in quadrants III and IV. 2. Four types of anatomic variations between the SCIA and SIEA were found from MDCTA.Type I:SCIA and SIEA arised from a common stem;Type II:SIEA was absent;Type III:SCIA and SIEA had separate origins.Type IV:superficial and deep branches of SCIA had separate origins.In clinical cases,MDCTA was applied to plan the lower abdominal flap combined with L.N flap in two cases.The plan in inguinal donor site of two cases did not change during operation.Both flaps survived. The therapeutic effect of long-term follow-up is still ongoing.Conclusion1. Quadrant I has more LNs than other three quadrants and the LNs in quadrant I mostly are supplied by SCIA. The LNs in quadrant II mostly are supplied by SIEA. Both quadrants can provide L.N flap with a certain number of L.Ns. However, these data can just provide evidence to help surgeons choose a reasonable donor site and the number of LNs to be transferred. The most appropriate number of LNs still needs further study.2. The classification of variations can provides a reference if surgeons meet similar anatomic variations in the future.MDCTA can become a reliable method to plan L.N.flap especially when combined with the lower abdominal flap.MDCTA can provide accurate information about the anatomic variation and facilitate surgeons to make a plan preoperatively. However, how to harvest the flap and which vascular pedicle to choose are still depended on surgeons’decisions.The surgeons need to adjust the plan flexibly according to the intraoperative situation. |
PDF Full Text Request