中国修复重建外科杂志

中国修复重建外科杂志

双蒂腹部皮瓣单侧乳房再造的应用

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目的 探讨双蒂腹部皮瓣单侧乳房再造的临床效果。 方法 回顾分析 2014 年 3 月—2018 年 3 月,19 例接受双蒂腹部皮瓣单侧乳房再造女性患者的临床资料。患者年龄 32~51 岁,中位年龄 45 岁。一期乳房再造 3 例,二期 16 例。左侧 7 例,右侧 12 例。术中采取带蒂横行腹直肌肌皮瓣加对侧游离横行腹直肌肌皮瓣 8 例,带蒂横行腹直肌肌皮瓣加对侧腹壁下动脉穿支皮瓣 3 例,双侧腹壁下动脉穿支皮瓣 7 例,一侧保留部分肌肉的游离横行腹直肌肌皮瓣加对侧腹壁下穿支皮瓣 1 例。腹部皮瓣切取范围为 24 cm×7 cm~43 cm×13 cm。供区直接缝合。 结果 术后 1 例发生皮瓣血管危象,经探查处理后缓解;1 例腹部切口愈合不良,经清创后愈合。其余皮瓣均顺利成活,供区切口均Ⅰ期愈合。术后患者均获随访,随访时间 4~42 个月,中位时间 12 个月。术后 4 例行再造乳房修整术,2 例因对侧乳房下垂进行对侧乳房下垂矫正术。末次随访时采用 BREAST-Q 评分系统评价,腹部评分为(84.1±11.7)分,胸部评分为(86.5±8.9)分,乳房评分为(67.6±16.4)分。 结论 对于体型较纤瘦以及存在腹部切口瘢痕尤其是纵向切口的患者,双蒂腹部皮瓣能够提供充足组织量和良好血供,是一种较好的自体组织单侧乳房再造方法。

Objective To explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction. Methods Between March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Unilateral breast reconstruction were performed for 8 patients with unilateral pedicle transverse rectus abdominis musculocutaneous (TRAM) flap and contralateral free TRAM flap, for 3 patients with pedicle TRAM flap and contralateral deep inferior epigastric perforator (DIEP) flap, for 7 patients with bilateral DIEP flaps, for 1 patient with free muscle-sparing TRAM flap and contralateral DIEP flap. The size abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly. Results The patients were followed up for a median period of 12 months (range, 4-42 months).Vascular crisis was ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdomen incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complications. Four patients received reparative operation of their reconstructive breast, and 2 patients received mamopexy of the contralateral breast due to mastoptosis. The abdominal BREAST-Q score was 84.1±11.7, chest score was 86.5±8.9, and breast score was 67.6±16.4 at last follow-up. Conclusion The dual-pedicle abdominal flap for unilateral breast reconstruction provides adequate soft tissue volume and good blood supply. It is a reliable and effective breast reconstructive method for patients who need large tissue volume to make symmetric with the contralateral breast, or slim patients with few tissue in the donor site, or patients with scares in the donor site, especially vertical abdominal scars.

关键词: 乳房再造; 双蒂皮瓣; 腹部皮瓣

Key words: Breast reconstruction; dual-pedicle flap; abdominal flap

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