Affiliations: Anatomy Section, Department of Molecular Medicine, University of Padova, Padova, Italy | Department of Medicine, University of Padova, Padova, Italy | Section of Radiology, Euganea Medica Center, Padova, Italy | Unità Operativa Complessa di Angiologia Azienda Ospedale, Università di Padova, Padova, Italy | Plastic Surgery Clinic, Department of Medical and Surgical Specialties, University of Padova, Padova, Italy
Note: [] These authors contributed equally to this work.
Note: [] These authors contributed equally to this work.
Note: [] Corresponding author: Raffaele De Caro, MD, Anatomy Section, Department of Molecular Medicine, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy. Tel.: +39 049 8272327; Fax: +39 049 8272319; E-mail: rdecaro@unipd.it
Abstract: Obesity is associated with structural alterations in subcutaneous small resistance arteries. The aim of the present work is to study modifications of perforators vessels of abdominal wall and subcutaneous tissue characteristics in obese patients after massive weight loss. An anatomo-radiologic study was carried out on 15 patients (5M, 10F, mean age 54.9y), who underwent abdominoplasty after massive weight loss. Their pre-operative Computed Tomographic (CT) results of the anterior abdominal wall were compared with CT of 15 normal weighted controls. Anatomo-microscopic and morphometric examinations were conducted on full-thickness specimens of panniculectomy samples. 10 right panniculectomy were sampled from donor cadavers. All the measurements were taken on transverse sections. In patients, at CT the mean luminal diameter (LD) and standard deviation of perforator branches of the deep inferior epigastric artery (DIEA) was 3.7 ± 0.4 mm (control 2.2 ± 0.1 mm; p < 0.05). At microscopic examination, the wall thickness of perforator arteries was 212.7 μ ± 83.9 versus 143.9 ± 32.8 (p < 0.05) deep to the superficial fascia and 120.4 μ ± 74.8 versus 72.3 ± 23.5 (p < 0.05) superficial to it. A thickening of the muscular layer was observable and the tunica media represented 71.4% ± 5.6 of the whole area of the wall (controls 37.1% ± 3.5, p < 0.0001). Our data demonstrate that the major LD of the perforators in patients matches with hypertrophy of the tunica media and we think that the major thickness of perforator walls can facilitate the microsurgical technique in free microsurgical flap reconstruction.
