不同形式带蒂背阔肌肌皮瓣移植补救性修复放疗后下腹部皮瓣再造乳房部分硬化  

Salvage repairment of partial sclerosis of reconstructed breast with lower abdominal flap after radiotherapy with different types of pedicled latissimus dorsi myocutaneous flap

作　　者：宋达疆[1] 李赞[1] 章一新[2] Song Dajiang;Li Zan;Zhang Yixin(Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha 410008,China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]上海交通大学医学院附属第九人民医院整形外科,上海200011

出　　处：《中华整形外科杂志》2022年第12期1315-1322,共8页Chinese Journal of Plastic Surgery

摘　　要：目的探讨不同形式带蒂背阔肌肌皮瓣移植补救性修复放疗后下腹部皮瓣再造乳房部分硬化的临床效果。方法回顾性分析2013年8月至2020年10月湖南省肿瘤医院收治的采用不同形式下腹部皮瓣移植完成乳腺癌术后即刻乳房再造并接受放射治疗的女性患者资料。放射治疗后随访发现部分再造乳房有不同程度的皮瓣硬化挛缩表现,对切除硬结后继发缺损较大的患者采用不同形式的带蒂背阔肌肌皮瓣移植修复。术后随访密切观察皮瓣成活情况、瘢痕增生情况、再造乳房外形质地及供区功能恢复情况。结果共纳入患者246例,年龄29~63岁,平均42.7岁,其中18例采用带蒂腹直肌肌皮瓣、92例采用单侧游离腹壁下动脉穿支皮瓣(包括单穿支皮瓣41例和双穿支皮瓣51例)、71例采用双侧游离腹壁下动脉穿支皮瓣、65例采用带蒂腹直肌肌皮瓣联合游离腹壁下动脉穿支皮瓣移植完成乳腺癌术后即刻乳房再造,皮瓣面积为27.0 cm×10.0 cm~34.0 cm×14.0 cm。所有下腹部皮瓣移植乳房再造手术病例术后早期未见明显并发症。放射治疗后随访发现28例再造乳房有不同程度的皮瓣硬化挛缩表现(包括带蒂腹直肌肌皮瓣9例,单侧单穿支游离腹壁下动脉穿支皮瓣19例),其中9例拒绝硬结切除手术,13例接受硬结切除和局部组织转移修复手术,另外6例切除硬结后继发缺损较大,采用不同形式带蒂背阔肌肌皮瓣移植修复,具体包括传统背阔肌肌皮瓣4例,保留胸背神经和大部分背阔肌的改良背阔肌肌皮瓣2例,皮瓣面积为18.0 cm×6.0 cm~24.0 cm×8.0 cm。术后早期有1例带蒂背阔肌肌皮瓣表现为轻度的灌大于流,术后2 d自行恢复正常。所有皮瓣完全成活,住院时间5~10 d。术后随访(8.5±0.7)个月(6~20个月),再造乳房外形满意,背部仅遗留线性瘢痕,上肢功能活动未见明显受限。结论应用不同形式带蒂背阔肌肌皮瓣移植补救性修复下Objective To discuss the salvage repairment strategy of partial sclerosis of reconstructed breast with lower abdominal flap after radiotherapy with different types of pedicled latissimus dorsi myocutaneous flap.Methods The clinical data of female breast cancer patients received various forms of lower abdominal flaps after mastectomy who needed radiotherapy in Hunan Cancer Hospital from August 2013 to October 2020 were analyzed retrospectively.The follow-up after radiotherapy showed that different degrees of flap sclerosis contracture occurred in some cases of reconstructed breast,and different forms of pedicled latissimus dorsi myocutaneous flap were used for repair large secondary defects after sclerotomy.The survival of skin flap,scar hyperplasia,appearance and texture of reconstructed breast and functional recovery of donor site were closely observed after operation.Results Altogether 246 female breast cancer patients were admitted,the age ranged from 29 to 63 years,with an average age of 42.7 years.Different types of lower abdominal flaps were used for immediate breast reconstruction after breast cancer,including 18 cases of pedicled rectus abdominis flap,92 cases of unilateral free deep inferior epigastric artery perforator flap(including 41 cases of single perforator flap and 51 cases of bilateral perforator flap),71 cases of bilateral free deep inferior epigastric artery perforator flap,and 65 cases of pedicled rectus abdominis myocutaneous flap combined with free deep inferior epigastric artery perforator flap,flap size ranged from 27.0 cm×10.0 cm to 34.0 cm×14.0 cm.There were no obvious complications in the early postoperative period in all cases of breast reconstruction with lower abdominal flap transplantation.Follow up after radiotherapy found that 28 cases of reconstructed breast had different degrees of skin flap sclerotic contracture(including 9 cases of pedicled rectus abdominis myocutaneous flap and 19 cases of unilateral single perforator free deep inferior epigastric artery perforator flap),o

关 键 词：肌皮瓣 背阔肌肌皮瓣 横行腹直肌肌皮瓣 腹壁下动脉穿支皮瓣 放射治疗 乳房再造 

分 类 号：R622[医药卫生—整形外科]