再造乳房术中腹壁下动脉穿支皮瓣切取失败采用股深动脉穿支皮瓣补救一例  

A case of using profunda artery perforator flap as an intraoperative salvage for failed deep inferior epigastric artery perforator flap harvesting in autologous breast reconstruction

作　　者：宋达疆[1] 李赞[1] 周晓[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;Zhou Xiao;Zhang Yixin;Peng Xiaowei;Zhou Bo;Lyu Chunliu;Wu Peng;Tang Yuanyuan(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复外科,200011

出　　处：《中华烧伤杂志》2020年第9期876-879,共4页Chinese Journal of Burns

基　　金：湖南省自然科学基金面上项目(2018JJ2241、2018JJ2242);湖南省肿瘤整形外科临床医学研究中心平台建设专项(2013TP4087);湖南省科卫联合项目(2018JJ6028);湖南省卫生健康委员会课题(B2019092);长沙市科技计划基础研究项目(kq1901074、kq1901077)。

摘　　要：2019年4月11日,湖南省肿瘤医院收治1例36岁女性患者。接受右侧乳腺癌改良根治术后5年,患者入院后计划行右侧胸壁瘢痕整复+游离腹壁下动脉穿支(DIEP)皮瓣移植+右侧乳房再造+左侧乳房上提术。右侧胸壁瘢痕切除后创面面积为18 cm×10 cm,术中误伤DIEP血管蒂,转而设计左侧大腿内侧股深动脉穿支(PAP)皮瓣,皮瓣面积为20 cm×11 cm、厚4.5 cm、穿支血管蒂长度为7.6 cm,皮瓣质量为360 g。转移皮瓣修复右侧乳房缺损并填塞深部腔隙,PAP血管蒂与右侧胸廓内血管近端吻合。术中见皮瓣血运良好,同期完成左侧乳房上提术,大腿及腹部皮瓣供区直接拉拢闭合。术后皮瓣存活良好,供区愈合良好。术后随访7个月,大腿供区外观功能好,未见明显并发症,重建乳房较对侧小。本病例提示PAP皮瓣在自体组织乳房再造中可作为DIEP皮瓣切取失败的有效替代。On April 11,2019,a 36-year-old female patient was admitted to Hunan Cancer Hospital.Five years after the modified radical mastectomy for right breast cancer,she planned to undergo scar releasing and reconstruction of right chest wall and free deep inferior epigastric artery perforator(DIEP)flap transfer,right breast reconstruction,and left breast mastopexy.The defect of right chest wall after scar resection was 18 cm×10 cm.During the operation,the vascular pedicle of DIEP flap was accidentally injured,then the profunda artery perforator flap in left inner thigh was designed for salvage.The size of the flap was 20 cm×11 cm,the thickness was 4.5 cm,the length of perforator vessel pedicle was 7.6 cm,and the weight of the flap was 360 g.The right breast defect was repaired with the transferred flap and the deep cavity was filled.The vascular pedicle of profunda artery was anastomosed with the proximal end of the right internal mammary artery.The blood supply of the flap was good during surgery.The left breast mastopexy was completed at the same time,and the donor site of thigh and abdomen was closed directly.The flap survived well and the donor site healed well after surgery.During the follow-up of 7 months post surgery,the appearance and function of thigh donor site were good,no obvious complications were found,and the reconstructed breast was smaller than the contralateral side.This case suggests that the profunda artery perforator flap could be a valuable option as an alternative for DIEP harvesting failure for autologous breast reconstruction.

关 键 词：乳腺肿瘤 外科皮瓣 乳房成形术 

分 类 号：R632.1[医药卫生—外科学] R329.2+8[医药卫生—临床医学]