Die Gefäßarchitektur der Bauchwand und ihre Stellung in der Plastischen Chirurgie : eine anatomische Untersuchung

Background and Aim: Wound healing complications and / or necrosis of the umbilicus, due to decreased vascularisation as a result of plastic surgical interventions as in abdominoplasty or abdominal flap surgery e.g. TRAM-flaps, VRAM-flaps, DIEP-flaps and SIEA-flaps are frequent. Aim of this study is to define territories of the abdominal wall which run the risk of decreased vascularisation in order to optimise plastic surgical techniques.Methods: Twelve fresh and unfixed human corpes of either sex (70-91 years old) are investigated. The inferior epigastric artery is dissected and cannulated bilaterally above the inguinal ligament. A mixture of barium-sulfate, lead-mennige and pulverised gelatine is then injected. All the abdominal walls are dissected en bloc. Afterwards some specimens are partially dissected in longitudinal stripes. Finally x-rays, both in standard and mammography technique are taken.Results: In respect of the centrally situated umbilicus, the epigastric vessels show either a converging or diverging orientation. The epigastric arteries divide into medial and lateral branches. The lateral branches of the inferior epigastric arteries show a stronger diameter than the medial branches. The side-branches of the superior epigastric arteries are of the same diameter. The terminal branches of the inferior and superior epigastric arteries anastomose on an average of 4,3cm + / - 0,2cm above the umbilicus. The umbilicus itself receives blood supply by separate axial vessels (umbilical branches) of the medial inferior epigastric branches. Terminal branches of both the inferior and superior epigastric arteries as well as the caudal intercostal arteries anastomose in the lateral regions of the abdominal wall.Conclusions: Surgical intervention of the umbilicus and its positioning in abdominoplasty or abdominal flap surgery e.g. TRAM-flaps, VRAM-flaps, DIEP-flaps and SIEA-flaps can affect the vascularisation of the tissue. Sufficient blood supply by the umbilical branches (small caliber vessels) is being tested. Mechanical stress of the umbilicus in abdominoplasty or abdominal flap surgery can lead to post-surgical wound healing complications and / or necrosis. Therefore excessive traction and torsion should be avoided while positioning the umbilicus. The larger the remaining fat layer of the abdominal wall the greater the vertical traction. Additional liposuction around the umbilicus can reduce vertical traction, so might SAL (suction-assisted lipectomy) and PTS (progressive tension sutures). A broadly dissected basis of the umbilical stalk will contribute to stability but will not result in increased vascularisation regarding the axial position of the umbilical vessels.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2008

Author dc:creator

• Okafor, Chukwubikem Akabogu

Contributors dc:contributor

• Pallua, Norbert

• info:eu-repo/classification/ddc/610
• Bauchwand
• Anatomie
• Medizin
• Bauchnabel
• A. epigastrica inferior et superior
• Rr. umbilicales
• Abdominal wall
• Anatomy
• Umbilicus
• Inferior and superior epigastric artery
• Umbilical branches

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112460%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A49892