摘要
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行切口的患者,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 dualpedicle 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 of abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly. Results Vascular crisis ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdominal incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complication. The patients were followed up with a median period of 12 months (range, 4-42 months). 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 scars in the donor site, especially vertical abdominal scars.
作者
李广学
穆籣
杨锴
彭喆
刘岩
毕晔
朱怡
王偲
王祎
臧荟然
曹赛赛
张沛阳
LI Guangxue;MU Lan;YANG Kai;PENG Zhe;LIU Yan;BI Ye;ZHU Yi;WANG Cai;WANG Yi;ZANG Huiran;CAO Saisai;ZHANG Peiyang(Department of Plastic and Reconstructive Surgery,Peking University People's Hospital,Beijing,100044,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2019年第1期70-74,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
乳房再造
双蒂皮瓣
腹部皮瓣
Breast reconstruction
dual-pedicle flap
abdominal flap
作者简介
通信作者:穆籣/共同第一作者(曾用名:穆兰花),Email:mulan666@aliyun.com
