Investigation of Intraflap Vascular Anastomosis in Extended Latissimus Dorsi Flap

2023 Fiscal Year Final Research Report

• Project/Area Number: 20K09869
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 56070:Plastic and reconstructive surgery-related
• Research Institution: Nagoya City University
• Principal Investigator: Toriyama Kazuhiro 名古屋市立大学, 医薬学総合研究院(医学), 教授 (40314017)
• Co-Investigator(Kenkyū-buntansha): 佐藤 秀吉 名古屋市立大学, 医薬学総合研究院(医学), 研究員 (70528968)
• Project Period (FY): 2020-04-01 – 2024-03-31
• Keywords: 拡大広背筋 / 皮弁内血管吻合 / 穿通枝 / 3Dカメラ / キャダバー

Outline of Final Research Achievements

This study aimed to enhance the distal blood flow in extended latissimus dorsi flaps used for breast reconstruction, ensuring the safe and reliable transplantation of the entire flap. Preoperative contrast-enhanced CT scans confirmed the presence of lumbar artery perforators at the distal (caudal) end of the latissimus dorsi in all cases. Cadaver dissections identified veins at the level of the lateral thoracic anterior axillary line that could be used for anastomosis. Clinically, additional anastomoses were performed in five cases, resulting in stable blood flow.
3D imaging analysis revealed that the breast volume after reconstruction did not show significant reduction within the first year post-surgery, indicating that the volume was well-maintained. However, a notable issue was the gradual atrophy of the latissimus dorsi muscle, making precise evaluation of the distal area challenging over time.

Free Research Field

乳房再建

Academic Significance and Societal Importance of the Research Achievements

本研究は、乳房再建における拡大広背筋皮弁の血流増強に関する新たな知見を提供します。具体的には、術前の造影CTとキャダバーを用いて、術中のＩＣＧを用いて、どの穿通枝をどこに吻合すべきかを明らかにした。これにより、拡大広背筋皮弁の乳房再建の成功率が向上することが期待されます。
乳がん患者にとって乳房再建は身体的・精神的回復の重要な要素です。本研究の成果により、より安全で効果的な再建手術が提供されることで、患者のQOL（生活の質）が向上します。特に、血流不全による合併症のリスクが低減されるため、手術後の回復が迅速になり、医療コストの削減にも寄与します。