胸背动脉前锯肌支在带蒂背阔肌肌皮瓣移植乳房再造中的补救作用  

Salvage role of anterior serratus branch of thoracodorsal artery in breast reconstruction with pedicled latissimus dorsi myocutaneous flap

作　　者：宋达疆[1] 李赞[1] 章一新[2] 王蕾[3] 宋爱莉[3] Song Dajiang;Li Zan;Zhang Yixin;Wang Lei;Song Aili(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;Department of Breast and Thyroid Surgery,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,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200011 [3]山东中医药大学附属医院乳腺甲状腺外科,济南250014

出　　处：《中华整形外科杂志》2022年第6期612-618,共7页Chinese Journal of Plastic Surgery

摘　　要：目的探讨胸背动脉前锯肌支在带蒂背阔肌肌皮瓣移植乳房再造中的补救作用。方法2015年9月至2019年12月,对4具新鲜成年女性尸体标本进行解剖,观测胸背动脉前锯肌支的数量、长度、直径及来源。回顾性分析2015年3月至2019年3月湖南省肿瘤医院肿瘤整形外科收治的行乳腺癌改良根治术后应用带蒂背阔肌肌皮瓣移植即刻再造乳房的患者临床资料。在分离、切取带蒂背阔肌肌皮瓣的过程中发现患者的胸背动脉受损,改用以胸背动脉前锯肌支为蒂制备背阔肌肌皮瓣再造乳房。术后对皮瓣成活情况、乳房外观和质地、乳腺癌有无复发以及供区情况进行随访。结果在4具(8侧)标本中共发现11条前锯肌支,长度为(6.3±1.8)cm,直径为(2.4±0.4)mm,其中7条发自胸背动脉主干,3条发自胸背动脉垂直支,1条发自胸背动脉水平支。临床病例共纳入6例女性单侧乳腺癌患者,年龄29~61岁,平均42.7岁;病程(10.7±5.4)个月(2~36个月)。行乳腺癌改良根治术后继发乳房缺损面积为14 cm×6 cm~16 cm×7 cm,术中切取背阔肌肌皮瓣皮岛面积为13 cm×6 cm~17 cm×6 cm。术后皮瓣均完全成活,再造乳房外形可。术后随访9~28个月,平均13.7个月,所有患者乳房外观和质地满意,均未见局部复发,供区仅遗留线性瘢痕,肩关节活动无影响。结论胸背动脉前锯肌支解剖恒定,与胸背血管相交通,可以为背阔肌供血;以胸背动脉前锯肌支为蒂可有效保证背阔肌肌皮瓣的血运,可作为胸背动脉主干损伤情况下乳房再造的补救方法。Objective To investigate the salvage role of anterior serratus branch of thoracodorsal artery in breast reconstruction with pedicled latissimus dorsi myocutaneous flap.Methods The anatomical study was conducted from September 2015 to December 2019.Four fresh adult female cadavers were dissected to measure the number,length,diameter and origin of the anterior serratus branch of the thoracodorsal artery.The clinical data of patients who underwent modified radical mastectomy and immediate breast reconstruction with pedicled latissimus dorsi myocutaneous flap from March 2015 to March 2019 were analyzed retrospectively.It was found that the thoracodorsal artery was damaged during the flap dissection and harvestion.The latissimus dorsi myocutaneous flap was harvested pedicled with the anterior serratus branch of the thoracodorsal artery as the pedicle to reconstruct the breast instead.Postoperative flap survival,breast appearance and texture,cancer recurrence and donor site were followed up.Results A total of 11 branches of anterior serratus muscle were found in 4 specimens(8 sides),with a length of(6.3±1.8)cm and a diameter of(2.4±0.4)mm,including 7 from the trunk of dorsal thoracic artery,3 from the vertical branch of dorsal thoracic artery and 1 from the horizontal branch of dorsal thoracic artery.A total of 6 female breast cancer patients aged 29-61 years,mean 42.7 years,were included in the clinical cases.The course of disease ranged from 2 to 36 months[(10.7±5.4)months].The area of secondary breast defect after modified mastectomy was 14 cm×6 cm to 16 cm×7 cm,the area of latissimus dorsi flap was 13 cm×6 cm to 17 cm×6 cm.All flaps survived thoroughly,the appearance of reconstructed breast was good.The follow-up ranged from 9 to 28 months,with an average of 13.7 months.The breast appearance and texture of all patients were satisfactory,there was no local recurrence,only linear scar was left in the donor area,and the shoulder joint activity was not affected.Conclusions The anatomy of the anterior serratus br

关 键 词：外科皮瓣 胸背动脉 前锯肌支 带蒂皮瓣 背阔肌肌皮瓣 乳房再造 

分 类 号：R737.9[医药卫生—肿瘤]