双侧游离股后内侧皮瓣移植再造乳房单侧的经验  

Experience of bilateral free posteromedial thigh flaps for unilateral breast reconstruction

作　　者：宋达疆[1] 李赞[1] 章一新[2] Song Dajiang;Li Zan;Zhang Yixin(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 200000,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

出　　处：《中华整形外科杂志》2023年第2期190-198,共9页Chinese Journal of Plastic Surgery

摘　　要：目的探讨应用双侧游离股后内侧皮瓣再造单侧乳房中的技术要点和注意事项。方法收集2018年10月至2020年12月湖南省肿瘤医院肿瘤整形外科收治的乳腺癌改良根治术后行即刻或延期双侧游离股后内侧皮瓣移植再造一侧乳房患者的临床资料,进行回顾性分析。根据血管蒂来源,切取的股后内侧皮瓣包括6种类型:股动脉穿支皮瓣、股薄肌肌皮瓣、大收肌穿支皮瓣、半膜肌穿支皮瓣、股后皮神经营养血管穿支皮瓣、坐骨神经营养血管穿支皮瓣。血管吻合方式包括4种:(1)外增压方式1,胸廓内血管近心端和远心端与两侧皮瓣血管蒂分别吻合;(2)外增压方式2,胸廓内血管和胸背血管与两侧皮瓣血管蒂分别吻合;(3)内增压方式,胸廓内血管与一侧皮瓣血管蒂吻合,皮瓣血管蒂分支与另一侧皮瓣血管蒂吻合;(4)外增压结合内增压方式,胸廓内血管和2套皮瓣血管蒂灵活组合。两侧股后内侧皮瓣摆放方式包括3种:横行摆放、垂直摆放、斜行摆放。对术后皮瓣成活情况、再造乳房外形、供区瘢痕、对下肢功能的影响及乳腺癌复发情况进行随访。结果共纳入12例患者,年龄(37.4±3.6)岁(27~47岁)。肿瘤均为单侧,其中左侧7例,右侧5例;即刻乳房再造8例,延期乳房再造4例。术中共切取24块股后内侧皮瓣,包括:股动脉穿支皮瓣1块,股薄肌皮瓣6块,大收肌穿支皮瓣14块,半膜肌穿支皮瓣1块,股后皮神经营养血管穿支皮瓣1块,坐骨神经营养血管穿支皮瓣1块。血管吻合方式:外增压方式1有5例,外增压方式2有4例,内增压方式有2例,外增压结合内增压方式有1例。皮瓣摆放方式:横行摆放3例,垂直摆放4例,斜行摆放5例。皮瓣长(20.6±0.4) cm、宽(7.1±0.3) cm、厚(3.6±0.5) cm,血管蒂长度为(6.9±0.5) cm,动脉管径为(1.9±0.3) mm,静脉管径为(1.8±0.6) mm。皮瓣平均质量为245 g(165~415 g)。2例患者术中同时行健侧乳房缩乳上提术,2�Objective To investigate the technical highlights and pitfalls in unilateral breast reconstruction with bilateral free posteromedial thigh flaps simultaneously.Methods Clinical data of patients who received one-staged or delayed unilateral breast reconstruction with bilateral free posteromedial thigh flaps transplantation after modified radical mastectomy were collected and retrospectively analyzed,from October 2018 to December 2020 in the Department of Oncology Plastic Surgery,Hunan Cancer Hospital.There are six types of posteromedial femoral flap:femoral artery perforator flap;gracilis myocutaneous flap;magnus adductor perforator flap;semimembranous muscle perforator flap;posterior femoral cutaneous nerve nutrient vessel perforator flap;sciatic nerve nutrient vessel perforator flap.There are 4 types of vascular anastomosis:(1)supercharge mode 1,the proximal and distal ends of the internal mammary vessels were anastomosed with the vascular pedicle of the bilateral flaps;(2)supercharge mode 2,anastomosis of internal mammary vessels and thoracodorsal vessels with vascular pedicles of bilateral flaps;(3)turbocharge mode,the internal mammary vessels were anastomosed with the vascular pedicle of one side of the flap,and the vascular pedicle branches of the flap were anastomosed with the vascular pedicle of the other side of flap;(4)supercharge mode combined with turbocharge mode,flexible combination of internal mammary vessels and two sets of flap vascular pedicles.There are three ways to place the posteromedial thigh flaps:horizontal placement;vertically placement;obliquely placement.The survival of the flaps,the shape of the reconstructed breast,the scar in the donor area,the influence on lower limb function and the recurrence of breast cancer were followed up.Results A total of 12 patients were included,with a mean age of 27 to 47 years(mean 37.4±3.6).7 cases on the left and 5 cases on the right.There were 8 cases of one-staged breast reconstruction and 4 cases of delayed breast reconstruction.A total of 24 media

关 键 词：乳腺肿瘤 股后内侧皮瓣 乳房再造 

分 类 号：R655.8[医药卫生—外科学]