双侧臂内侧穿支皮瓣移植即刻乳房再造1例  

One case of immediate breast reconstruction with bilateral medial arm perforator flaps

作　　者：宋达疆[1] 李赞[1] 章一新[2] 周波[1] 吕春柳[1] 唐园园 易亮 罗振华 Song Dajiang;Li Zan;Zhang Yixin;Zhou Bo;Lyu Chunliu;Tang Yuanyuan;Yi Liang;Luo Zhenhua(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形外科,上海200011

出　　处：《中华整形外科杂志》2023年第5期514-519,共6页Chinese Journal of Plastic Surgery

基　　金：湖南省卫计委课题项目(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：2021年6月15日,湖南省肿瘤医院肿瘤整形外科收治1例43岁女性右侧乳腺癌患者。患者13年前曾接受左侧乳腺癌改良根治术,6年前接受带蒂腹直肌肌皮瓣移植左侧乳房再造术。入院后行右侧乳腺癌改良根治术+双侧游离臂内侧穿支皮瓣移植右侧乳房再造术,术中以同侧臂内侧皮瓣再造外侧半乳房,尺侧上副血管蒂与胸外侧动脉近心端和胸外侧静脉远心端吻合,以对侧臂内侧皮瓣再造内侧半乳房,尺侧上副血管蒂与胸廓内血管吻合。完成血管吻合后见皮瓣通血良好,两侧臂内侧皮瓣供区直接拉拢缝合。患者术后病程稳定,皮瓣成活良好,供区愈合良好。术后随访2个月,皮瓣供区外观、功能好,未见明显并发症,再造乳房外形欠满意。本病例提示双侧游离臂内侧穿支皮瓣组合移植适合用于再造中小容量的乳房,不足以用于大容量乳房再造。On June 15,2021,a female patient with right breast cancer aged 43 years old was admitted in Hunan Cancer Hospital.She received left mastectomy 13 years ago and left breast reconstruction with pedicled rectus abdominis myuocutaneous flap 6 years ago.After admission,she received right mastectomy and immediate right breast reconstruction with bilateral free medial arm perforator flaps.The lateral side of the breast was reconstructed with the ipsilateral medial arm flap.The superior ulnar collateral vessels were anastomosed with the proximal end of the lateral thoracic artery and distal end of the lateral thoracic vein.And the contralateral medial arm flap was used to reconstruct the medial part of the breast.The superior ulnar collateral vessels were anastomosed with the proximal and distal ends of the internal mammary vessels.After revascularization,the blood supply of the flap was good,and the donor sites were closed directly.The postoperative course of the patient was stable,the flap survived well,and the donor area healed well.In the two-month follow-up,the appearance and function of the flap donor area was good,there were no obvious complications,while the reconstructed breast shape was not satisfactory.This case suggests that the combined transplantation of bilateral free arm medial perforator flaps is suitable for small and medium-sized breast reconstruction,but not enough for large-volume breast reconstruction.

关 键 词：乳腺肿瘤 腹壁下动脉穿支皮瓣 臂内侧皮瓣 乳房再造 

分 类 号：R655.8[医药卫生—外科学]