皮瓣移植乳房再造术的并发症及处理  

Treatment of complications of breast reconstruction with flap transfer

作　　者：郑厚兵[1] 单秀英[1] 陈祥锦[2] 张惠灏[2] 朱有志[2] 王美水[1] 王彪[1] 

机构地区：[1]福建医科大学附属第一医院整形美容外科,福州350005 [2]福建医科大学附属第一医院乳腺外科,福州350005

出　　处：《中华医学美学美容杂志》2016年第5期270-273,共4页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：国家临床重点专科建设项目（2013-GJLCZD）

摘　　要：目的探讨皮瓣移植乳房再造术常见的并发症及其处理方法。方法2004--2015年，共完成55例皮瓣移植乳房再造术。横行腹直肌肌皮瓣（TRAM皮瓣）25例：23例下腹壁应用涤纶补片修复加强；保留部分腹直肌的TRAM皮瓣（M—STRAM皮瓣）15例，下腹壁均未应用补片修复；背阔肌肌皮瓣（LDM皮瓣）15例，其中5例联合应用乳房假体，1例Ⅱ期行再造乳房自体脂肪填充术。结果随访3个月至10年，出现各种并发症15例次：受区胸壁皮肤边缘坏死2例，移植皮瓣部分坏死、脂肪液化5例，经清创、换药或局部皮瓣转移修复后痊愈；组织纤维化3例。腹壁膨隆2例，1例经Ⅱ期腹壁补片修复后改善。供区切口裂开3例，经换药，Ⅱ期清创缝合后痊愈。结论对皮瓣组织移植乳房再造术常见并发症的原因进行分析，可避免不利因素，及时处理，可提高手术效果。Objective To discuss the common complications and treatments of breast reconstruction with tissue flaps. Methods From year 2004-2015, 55 cases of breast reconstruction using tissue flaps were conducted： 25 cases of transverse rectus abdomial myocataneous flap （TRAM flap）, 23 of which were reinforced with polyester patches to strengthen the lower abdominal wall; 15 cases of partial muscle-sparing TRAM flap （M-S TRAM flap）, without the use of reinforcement patches; 15 cases of latissimus dorsi myocutaneous flap （LDMF）, 5 of which were combined with breast implants. Autologous fat grafting was conducted in 1 case after LDMF reconstruction. Results 15 cases of various complications occurred as indicated by the follow-up study （duration of 3-11 years）, including 2 cases of wound edge necrosis on recipient flap, 5 cases of partial skin flap necrosis with fat liquefaction, 3 cases of tissue fibrosis, 2 cases of abdominal bulge and 3 cases of donor site incision dehiscence. In the case of skin flap necrosis and delayed wound healing, the classic methods were used for resolving such wounds including sharp debridement, dressing changes and local flap transfer. 1 case of abdominal weakness was corrected after stage H repair surgery. Conclusions By investigating the current findings on complications of tissue flaps it may allow for a detailed analysis of breast reconstruction, evaluating the causes of complication, taking preventive measures against unfavorable factors, and therefore improving surgical practice, which all contributes to optimizing the clinical outcomes.

关 键 词：乳房再造术 皮瓣 并发症 

分 类 号：R655.8[医药卫生—外科学]