Abstract
INTRODUCAO: A transferencia microvascular de tecido autogeno se tornou o padrao de referencia para a reconstrucao da mama. Como em qualquer reconstrucao com tecido livre, a escolha do vaso receptor e fundamental para o planejamento adequado na reconstrucao mamaria. O objetivo do presente estudo e determinar quais dentre os vasos receptores disponiveis (a arteria mamaria interna e seus vasos perfurantes ou os vasos circunflexos escapulares) sao mais adequados para a reconstrucao microvascular da mama. METODO: Foi realizada analise retrospectiva de 117 pacientes consecutivas submetidas a reconstrucao da mama microvascular, entre janeiro de 2005 e dezembro de 2007. Foi estabelecido um algoritmo que pode ser aplicado para a selecao do vaso receptor com base em alguns parâmetros, como disseccao axilar, tempo da reconstrucao (imediata ou tardia) e presenca de radioterapia pre-operatoria. Foram avaliadas as complicacoes relacionadas ao retalho, a taxa de conversao e os resultados clinicos. RESULTADOS: A arteria mamaria interna e seus vasos perfurantes e os vasos circunflexos escapulares sao adequados para a reconstrucao da mama, com taxas semelhantes de complicacoes e de viabilidade. Observou-se, tambem, maior risco de perda do retalho com o uso do retalho da arteria epigastrica inferior superficial em comparacao ao retalho da arteria epigastrica inferior profunda ou retalho musculocutâneo abdominal transverso de musculo reto do abdome com preservacao do musculo. CONCLUSOES: A reconstrucao mamaria microcirurgica e um metodo seguro e confiavel, com alta viabilidade do retalho e baixas taxas de complicacao.
Highlights
Microvascular breast reconstruction advantages are well known
As in any free tissue reconstruction, recipient vessel choice is fundamental for adequate planning in breast reconstruction
The purpose of the present study is to determine which of the available recipient vessels are adequate for microvascular breast reconstruction
Summary
Microvascular breast reconstruction advantages are well known. The flap is better vascularised, allows better shaping, more natural result and less abdominal wall morb idity.As in any free tissue reconstruction, recipient vessel choice is fundamental for adequate planning in breast re construction. The main concern is that any vessel diameter discrepancy may lead to thrombotic events, beside that, inad equate vessel choice affects the orientation and inset of the flap tissue, what may have significant impact on both the functional and aesthetic results[1]. These concepts are of great importance when selecting recipient vessels for the free flap breast reconstruction. Results: The internal mammary perforator, the internal mammary and the circumflex scapular are adequate recipient vessels for breast reconstruction, with similar rates of complications and viability. Conclusions: Microsurgical breast reconstruction is a safe and reliable method, with high flap viability and low complications
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