同时携带肋间动脉穿支与腹壁下动脉穿支保留部分腹直肌的游离腹直肌皮瓣再造乳房  

Muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction

作　　者：宋达疆[1] 李赞[1] 周晓[1] 章一新[2] 冯光[3] 周波[1] 吕春柳[1] 伍鹏 唐园园 易亮 罗振华 SONG Dajiang;LI Zan;ZHOU Xiao;ZHANG Yixin;FENG Guang;ZHOU Bo;LÜChunliu;WU Peng;TANG Yuanyuan;YI Liang;LUO Zhenhua(Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital,Changsha Hunan,410008,P.R.China;Department of Plastic and Reconstructive Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200000,P.R.China;Department of Burn and Plastic Surgery,the Fourth Affiliated Hospital of Chinese PLA General Hospital,Beijing,100048,P.R.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200000 [3]解放军总医院第四医学中心烧伤整形外科,北京100048

出　　处：《中国修复重建外科杂志》2021年第5期605-610,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：湖南省卫健委课题项目(B2019092、20201650、20200829);长沙市科技计划基础研究项目(kq1901074、kq1901077);湖南省自然科学基金科卫联合项目(2018JJ6028)。

摘　　要：目的探讨同时携带肋间动脉穿支与腹壁下动脉穿支保留部分腹直肌的游离腹直肌皮瓣再造乳房的技术、疗效及安全性。方法 2016年12月—2019年2月,对6例早期乳腺癌患者行改良根治术同期或二期应用游离腹直肌皮瓣移植再造乳房。患者年龄29~56岁,平均34.6岁。病程2~16个月,平均9.5个月。肿瘤位于外上象限4例,外下象限2例。病理检查示均为浸润性导管癌。乳腺癌分期:Ⅰ期4例,Ⅱ期2例。术中发现4例腹壁下动脉穿支血管位置靠近皮瓣边缘和脐旁,2例腹壁下动脉穿支血管较为细小(<0.3 mm),以腹壁下动脉穿支联合肋间动脉穿支制备保留部分腹直肌的游离腹直肌皮瓣移植修复。皮瓣长(28.9±0.2)cm、宽(12.1±0.4)cm、厚(4.4±0.3)cm,血管蒂长(11.5±0.2)cm,皮瓣质量(420.5±32.7)g。结果术后6例皮瓣完全成活,乳房切口均Ⅰ期愈合,无血管危象、供区积液、血肿、感染等情况发生。6例患者均获随访,随访时间12~36个月,平均26.8个月。再造乳房外形可,弹性好,无皮瓣挛缩变形;皮瓣供区仅遗留线性瘢痕,腹壁功能无影响。随访期间未出现乳腺癌复发转移。结论腹壁下动脉穿支血管位置靠近皮瓣边缘和脐旁或者过于细小会影响下腹部皮瓣血运,采用腹壁下动脉穿支联合肋间动脉穿支制备保留部分腹直肌的游离腹直肌皮瓣,可有效保证下腹部游离皮瓣的血运。Objective To explore the surgical technique, effectiveness, and safety of muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator for breast reconstruction. Methods Between December 2016 and February 2019, 6 cases of early breast cancer received modified radical surgery, lower abdominal flap was applied for one-or two-staged breast reconstruction. The average age of the patients was 34.6 years(range, 29-56 years). The disease duration ranged from 2 to 16 months, with an average of9.5 months. The tumor was located in the upper outer quadrant in 4 cases and the lower outer quadrant in 2 cases.Pathological examination showed that they were all invasive ductal carcinoma. Four cases of breast cancer were in stage Ⅰand 2 cases was in stage Ⅱ. During operation, the inferior epigastric artery perforators were found to be close to the upper edge of the flap and/or near the umbilical cord in 4 cases, the inferior epigastric artery perforator vessels were relatively small(<0.3 mm) in 2 cases;and the breast was reconstructed with muscle-sparing rectus abdominis myocutaneous flap vascularized with intercostal artery perforator and inferior epigastric artery perforator. The length, width, and thickness of the flap were(28.9±0.2),(12.1±0.4), and(4.4±0.3) cm, respectively. The length of the vascular pedicle was(11.5±0.2) cm and the weight of the flap was(420.5±32.7) g. Results All 6 muscle-sparing rectus abdominis myocutaneous flaps were successful, and the breast incisions healed by first intention. There was no vascular crisis, donor site effusion, hematoma,or infection. All 6 patients were followed up 12-36 months(mean, 26.8 months). The reconstructed breast had a good shape, good elasticity, and no flap contracture or deformation;only linear scars left at the donor site of the flap, and the abdominal wall function was not affected. During follow-up, there was no breast cancer recurrence and metastasis.Conclusion When the inferior epi

关 键 词：腹壁下动脉穿支 肋间动脉穿支 游离皮瓣 乳房再造 

分 类 号：R655.8[医药卫生—外科学]