分叶游离下腹部皮瓣移植乳房再造的血管吻合方式选择  

Selection of vascular anastomosis methods for breast reconstruction using lobed free lower abdominal flap transplantation

作　　者：宋达疆[1] 张天怡 王志远[3] 刘旭 李赞[1] 章一新[4] SONG Dajiang;ZHANG Tianyi;WANG Zhiyuan;LIU Xu;LI Zan;ZHANG Yixin(Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410008,China;Department of Breast Surgery,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Ultrasound Diagnosis Center,Hunan Province Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,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,湖南省长沙市410008 [2]哈尔滨医科大学附属第一医院乳腺外科,黑龙江省哈尔滨市150001 [3]湖南省肿瘤医院超声诊断中心,湖南省长沙市410008 [4]上海交通大学医学院附属第九人民医院整复外科,上海市200011

出　　处：《组织工程与重建外科》2024年第4期428-433,共6页Journal of Tissue Engineering and Reconstructive Surgery

基　　金：湖南省卫生健康委科研计划课题(202209024847)。

摘　　要：目的总结分叶游离下腹部皮瓣移植再造乳房的适应证和血管吻合方式选择。方法自2019年10月至2023年6月,在17例女性乳腺癌患者中完成分叶游离下腹部皮瓣移植乳房再造,包括10例即刻乳房再造和7例延期乳房再造。全部采用分叶游离下腹部皮瓣移植完成,包括M1型游离腹直肌皮瓣20侧,M2型6侧,M3型8侧。血管吻合方式具体包括:外增压方式9例,内增压方式8例。受区血管包括胸廓内血管近心端14侧,胸背血管主干10侧,前锯肌支3侧,胸外侧动静脉2例,胸廓内血管远心端5侧。结果每侧皮瓣长(14.2±0.4)cm、宽(11.5±1.0)cm、厚(4.9±0.3)cm。所有皮瓣血运良好,全部顺利成活。术后随访6~38个月,平均20.7个月,乳腺癌未见复发,再造乳房外形可,质地满意,无皮瓣挛缩变形,与健侧乳房外形基本对称;皮瓣供区及乳房受区仅遗留线性瘢痕,腹壁功能无明显影响。结论分叶游离下腹部皮瓣适用于底盘及垂度凸度都较大的乳房再造,选择合理的血管吻合方式可以确保皮瓣的自由摆放和满意的乳房塑形。Objective To summarize the indications and vascular anastomosis methods selection for the transplantation of lobed free lower abdominal flap for breast reconstruction.Methods From October 2019 to June 2023,17 female breast cancer patients received lobulated free lower abdominal flap transfer for breast reconstruction,including 10 cases of immediate breast reconstruction and 7 cases of delayed breast reconstruction.All the cases were completed by transplantation of lobulated free lower abdominal flaps,including 20 M1 type free rectus abdominis skin flaps,6 M2 types,and 8 M3 types.The specific vascular anastomosis methods include supercharge in 9 cases and turbocharge in 8 cases.The recipient vessels include 14 sides of the proximal end of the internal mammary vessels,10 sides of the main trunk of the thoracodorsal vessels,3 sides of the serratus anterior branches,2 cases of the lateral thoracic artery and vein,and 5 sides of the distal end of the internal mammary vessels.Results Each side flap had a length of(14.2±0.4)cm,a width of(11.5±1.0)cm,and a thickness of(4.9±0.3)cm.All flaps had good blood circulation and all survived smoothly.All patients were followed up for 6 to 38 months(20.7 months on average),no recurrence was noted.The reconstructed breasts had good appearance,satisfactory texture,no flap contracture and deformation,and was basically symmetrical with the healthy breast.The flap donor site and breast recipient area only had linear scars left,and there was no significant impact on abdominal wall function.Conclusion The lobed free lower abdominal flap is suitable for breast reconstruction with large base and sagging convexity.Choosing a reasonable vascular anastomosis method can ensure the free placement of the flap and satisfactory breast shaping.

关 键 词：分叶皮瓣 游离腹直肌皮瓣 乳房再造 乳腺癌 

分 类 号：R622[医药卫生—整形外科]