双侧游离股后内侧穿支皮瓣再造一侧乳房  

Bilateral free posteromedial thigh perforator flaps for unilateral breast reconstruction

作　　者：宋达疆[1] 李赞[1] 章一新[2] 彭小伟[1] 周波[1] 吕春柳[1] 伍鹏 唐园园 Song Dajiang;Li Zan;Zhang Yixin;Peng Xiaowei;Zhou Bo;Lyu Chunliu;Wu Peng;Tang Yuanyuan(Department of Oncology Plastic Surgery,Hunan Province 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,200011

出　　处：《中华整形外科杂志》2020年第3期263-269,共7页Chinese Journal of Plastic Surgery

基　　金：湖南省自然科学基金面上项目(2018JJ2242,2018JJ2241);湖南省科技计划项目(2014SK3002);湖南省卫计委课题项目(B2014-111)。

摘　　要：目的探讨双侧游离股后内侧穿支皮瓣再造一侧乳房的可行性。方法回顾性分析2018年10月至2019年6月湖南省肿瘤医院肿瘤整形外科收治的6例女性早期乳腺癌患者的临床资料。患者年龄31~47岁。肿瘤均为单侧,左侧3例,右侧3例;浸润性导管癌3例,浸润性小叶癌3例。对6例乳腺癌患者行一期或二期双侧游离股后内侧穿支皮瓣移植再造乳房。一期再造3例,乳腺肿块直径2.5~4.0 cm;二期再造3例。术后对皮瓣和供区的情况进行随访观察。结果6例患者手术过程顺利,切取皮瓣长(24.4±0.5)cm、宽(8.3±0.5)cm、厚(3.4±0.5)cm,血管蒂长度为(8.9±0.4)cm,动脉管径为(1.5±0.4)mm,静脉管径为(1.9±0.3)mm。皮瓣平均质量为235 g(165~345 g)。1例皮瓣供区术后1周出现淋巴漏,经持续负压吸引于2周后自行愈合。6例获5~8个月随访,平均5.5个月,所有皮瓣均成活,再造乳房外形可,弹性好,无皮瓣挛缩变形,供区仅遗留线性瘢痕,无下肢功能影响。6例效果均较满意,未发现乳腺癌复发。结论应用双侧游离股后内侧皮瓣移植再造一侧乳房效果较好,方法可行,可作为特殊情况下乳房再造的备选手术方案。Objective To explore the clinical application of bilateral free posteromedial thigh perforator flaps for unilateral breast reconstruction.Methods Retrospective analysis of bilateral free posteromedial thigh perforator flaps application in six breast cancer cases for immediate or two-staged breast reconstruction.The age of patients ranged from 31 to 47 years old.All cancer occurred in hemi-lateral,3 cases on left and 3 cases on right.Pathological diagnosis included invasive ductal carcinoma in 3 cases and invasive lobular carcinoma in 3 cases.One or two-staged breast reconstruction using bilateral free posteomedial thigh perforator flaps was carried out in 6 breast cancer patients.In stageⅠcases the breast tumor size ranged from 2.5 to 4.0 cm,(2.8±0.5)cm on average;3 cases of breast cancer were in stageⅠand 3 cases was in stageⅡ.Postoperative follow-up of recipient and donor sites were evaluated.Results The length of flap was(24.4±0.5)cm,the width of flap was(8.3±0.5)cm,the thickness of flap was(3.4±0.5)cm.The length of pedicle was(8.9±0.4)cm,the outer diameter of pedicle artery was(1.5±0.4)mm,the outer diameter of pedicle vein was(1.9±0.3)mm.The average weight of flap was 235 g(ranged from 165 g to 345 g).Lymphatic leakage occurred in the donor site in 1 case 1 week postoperatively and healed with continuous negative pressure suction in 2 weeks.All flaps survived totally.The reconstructed breasts’shape,texture and elasticity were good and no flap contracture deformation happened.Only linear scar left in the donor sites,the function of thighs was not affected.All 6 patients were followed up for 5-8 months(5.5 months on average)with satisfied result.No local recurrence happened.Conclusions Bilateral free posteromedial thigh perforator flaps transferring is feasible to reconstruct unilateral breast.

关 键 词：乳腺肿瘤 穿支皮瓣 股后内侧穿支 乳房再造术 

分 类 号：R737[医药卫生—肿瘤]