局部kiss皮瓣在局部晚期乳腺癌术后胸壁软组织缺损修复中的初步应用  

Local kiss flap for chest wall soft tissue reconstruction following mastectomy for locally advanced breast cancer

作　　者：薛兵建 王新星[1] 李凯强 解钧媛 甘丽 裴新红[1] Xue Bingjian;Wang Xinxing;Li Kaiqiang;Xie Junyuan;Gan Li;Pei Xinhong(Department of Breast Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院乳腺外科,郑州450052

出　　处：《中华整形外科杂志》2023年第4期359-365,共7页Chinese Journal of Plastic Surgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210288)。

摘　　要：目的探讨局部kiss皮瓣在局部晚期乳腺癌(LABC)切除术后胸壁软组织缺损修复中的初步应用效果。方法回顾性分析2020年6月至2021年7月郑州大学第一附属医院乳腺外科收治的LABC患者临床资料。所有患者均在新辅助化疗后行乳腺癌改良根治术,应用局部kiss皮瓣技术修复继发胸壁软组织缺损,术中于缺损下方和外上方设计2个局部邻位皮瓣(皮瓣A和皮瓣B),将皮瓣分别掀起后转移、拼接,共同修复胸壁缺损,供区直接拉拢缝合。术后常规观察皮瓣血运,记录皮瓣存活情况,根据患者手术前后的病理结果给予辅助全身治疗,伤口愈合后开始辅助放疗,并定期复查。结果共纳入5例女性LABC患者,年龄41~71岁,平均53.4岁,临床分期均为Ⅲ期(T3~4N2~3M0)。LABC术后胸壁缺损面积为12.0 cm×12.0 cm~22.0 cm×20.0 cm,切取的皮瓣A面积为7.0 cm×7.0 cm~14.0 cm×13.0 cm,皮瓣B面积为5.0 cm×4.0 cm~11.0 cm×7.0 cm。术后有1例患者皮瓣A远端出现部分坏死,其余4例皮瓣均全部成活;供区均恢复良好,未发生并发症。术后随访13~20个月,平均15.8个月,皮瓣修复效果满意,有1例未接受放疗的患者于术后4个月出现局部肿瘤复发,其余4例未见肿瘤复发和转移。结论局部kiss皮瓣技术操作简单、修复效果满意,是一种可行、可靠的LABC切除术后胸壁软组织缺损修复方法。Objective To investigate preliminary results of chest wall reconstruction with local kiss flap following mastectomy for locally advanced breast cancer(LABC).Methods Clinical data of the LABC patients receiving treatment at the Department of Breast Surgery,the First Affiliated Hospital of Zhengzhou University between June 2020 and July 2021 was retrospectively analyzed.All patients underwent modified radical mastectomy after neoadjuvant chemotherapy.And the local kiss flap was used for reconstruction of the secondary chest wall soft tissue defects.Two small local flaps were designed intraoperatively and harvested from inferior(flap A)and lateral(flap B)to the defect,respectively,resurfacing a large chest wall soft tissue defect side by side with primary closure of both two donor sites.The flap perfusion was routinely monitored postoperatively.Adjuvant systemic therapies were implemented based on both pre-and post-operative pathological results.And the adjuvant radiotherapy was started immediately after wound healed completely.All cases were followed up regularly.Results A total of five female patients were included,with an average age of 53.4(ranging from 41 to 71).StageⅢ(T3-4N2-3M0)breast cancer was diagnosed in all cases.After mastectomy,chest wall soft tissue defect was presented in all cases,ranging from 12.0 cm×12.0 cm to 22.0 cm×20.0 cm.The flap A measured from 7.0 cm×7.0 cm to 14.0 cm×13.0 cm and the flap B from 5.0 cm×4.0 cm to 11.0 cm×7.0 cm.Only 1 flap A suffered tip necrosis and the remnant flaps survived totally.All donor sites recovered uneventfully and no donor-site morbidity was noted.The mean post-operative follow-up period was 15.8 months(ranging from 13 to 20 months).No tumor recurrence or metastasis was noted in all patients,except one patient,who did not receive radiotherapy,suffered local recurrence 4 months after surgery.Conclusion Given its simplicity and satisfying results,the local kiss flap is a feasible and reliable reconstructive option for chest wall soft tissue defect reconstr

关 键 词：外科皮瓣 乳腺肿瘤 kiss皮瓣 胸壁软组织缺损 修复外科手术 

分 类 号：R737.9[医药卫生—肿瘤]