扩张器置入失败后采用腹壁下动脉穿支皮瓣移植再造乳房  

Deep inferior epigastric artery perforator flap transferred for breast reconstruction salvage after failed tissue expander implantation

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 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》2021年第7期719-725,共7页Chinese Journal of Plastic Surgery

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资助(2013TP4087);湖南省科卫联合项目(2018JJ6028);湖南省卫健委课题(B2019092)。

摘　　要：目的:探讨采用腹壁下动脉穿支(DIEP)皮瓣挽救扩张器置入失败并再造乳房的效果。方法:回顾性分析2016年7月至2019年1月湖南省肿瘤医院肿瘤整形外科采用DIEP皮瓣移植再造乳房补救乳腺癌改良根治术后扩张器置入乳房重建失败的患者资料。术后观察皮瓣成活情况、乳房形态以及供区伤口愈合情况和腹壁功能。结果:共纳入13例患者,均为女性,年龄28~53岁。既往曾行乳腺癌改良根治术后扩张器置入乳房重建术,需再造乳房均为单侧,左侧8例,右侧5例。其中3例发生扩张器感染取出,4例发生扩张器包膜挛缩移位,6例自感不适需要取出假体。13例患者共切取移植13块游离DIEP皮瓣,皮瓣长(25.5±0.6)cm、宽(12.6±0.4)cm、厚(5.9±0.7)cm,血管蒂长度为(11.3±0.4)cm。皮瓣平均重量为435 g(390~510 g)。平均手术时间为440 min(390~560 min)。6例患者选用胸廓内血管近端作为受区吻合血管,4例选用胸廓内血管近、远端作为受区吻合血管,2例选用胸背血管作为受区吻合血管,1例选用胸背血管和胸廓内血管近端作为受区吻合血管。所有DIEP皮瓣均一期顺利成活。术后随访16.5个月(12~39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,位置隐蔽,腹壁运动功能无明显受限。结论:DIEP皮瓣用于扩张器置入失败后的乳房再造,术后乳房形态良好,并发症少,是一种安全有效的治疗方法。Objective To present the authors’experience using a deep inferior epigastric artery perforator(DIEP)flap for the salvage of tissue expander implantation failed breast reconstruction.Methods A retrospective study was conducted of all patients who underwent breast reconstruction salvaged by means of a DIEP flap because of failed tissue expander implantation in the Department of Oncology Plastic Surgery of Hunan Province Cancer Hospital from July 2016 to January 2019.Flap survival,breast shape,wound healing and abdominal wall function were reviewed.Results A total of 13 patients,female,28 to 53 years old,were included in this study.All the patients had undergone modified mastectomy and failed tissue expander implantation before,and the expanders were removed because of infection in 3 cases,the capsule contracture and displacement in 4 cases and patients feeling uncomfortable and refused prosthesis implantation in 6 cases.Unilateral reconstruction was performed in all cases,8 cases of left breast and 5 cases of the right.Thirteen free DIEP flaps were harvested.The length,width and thickness of DIEP flap were(25.5±0.6)cm,(12.6±0.4)cm and(5.9±0.7)cm respectively,and the length of vascular pedicle was(11.3±0.4)cm.The average weight of the flap was 435 g(390-510 g).The average operation time was 440 min(390-560 min).The proximal end of internal mammary vessels were used as the recipient vessels in 6 cases,the proximal and distal end of internal mammary vessels were used as the recipient vessels in 4 cases,the thoracodorsal vessels in 2 cases and combined the thoracodorsal vessels and the proximal end of internal mammary vessels in 1 case.All flaps survived successfully.The average follow-up period was 16.5 months(range,12-39 months).The appearance and texture of reconstructed breast were good,and there was no flap contracture and deformation.Only concealed linear scar was left in the donor site.The motor function of abdominal wall was not limited.Conclusions Salvaging failed tissue expander implantation breast reco

关 键 词：乳腺肿瘤 乳房成形术 穿支皮瓣 腹壁下动脉 软组织扩张器 

分 类 号：R737.9[医药卫生—肿瘤]