双侧下腹部皮瓣联合双侧游离股后内侧皮瓣移植再造双侧乳房的策略和技术要点  

The strategy and technical keypoints of bilateral lower abdominal flaps combined with bilateral free posteromedial thigh flaps transplantation for bilateral breast reconstruction

作　　者：宋达疆[1] 张天怡 王志远[3] 刘旭 李赞[1] 王晓珍[4] Song Dajiang;Zhang Tianyi;Wang Zhiyuan;Liu Xu;Li Zan;Wang Xiaozhen(Department of Oncology Plastic Surgery,Hunan Cancer Hospital,Changsha 410008,China;Breast Surgery Department,the First Affiliated Hospital of Harbin Medical University,Harbin 150000,China;Ultrasound Diagnosis Center,Hunan Cancer Hospital,Changsha 410008,China;Breast Surgery Department,the First Bethune Hospital of Jilin University,Changchun 132000,China Surgery Department,the First Bethune Hospital of Jilin University,Changchun 132000,China)

机构地区：[1]湖南省肿瘤医院肿瘤整形外科,长沙410008 [2]哈尔滨医科大学附属第一医院乳腺外科,哈尔滨150000 [3]湖南省肿瘤医院超声诊断中心,长沙410008 [4]吉林大学白求恩第一医院乳腺外科,长春132000

出　　处：《中华整形外科杂志》2024年第12期1306-1314,共9页Chinese Journal of Plastic Surgery

基　　金：湖南省卫生健康委科研计划课题(202209024847)。

摘　　要：目的探讨双侧下腹部皮瓣联合双侧游离股后内侧皮瓣移植再造双侧乳房的策略和技术要点。方法回顾性分析2021年8月至2023年4月湖南省肿瘤医院肿瘤整形外科采用双侧下腹部皮瓣联合双侧游离股后内侧皮瓣移植再造双侧乳房患者的临床资料。根据受区血管性状和供区血管的解剖特点制定和灵活调整手术策略,其要点为:通过体格检查和影像学检查精确测量双侧乳房缺损的体积、形状和皮肤缺损范围,确定所需皮瓣的大小和形状;通过多普勒或彩超探测下腹部和双侧大腿后内侧供区穿支血管数量和供血能力,确定下腹部皮瓣游离或带蒂转移,在此基础上确定股后内侧皮瓣的放置与血管吻合位置。术后随访并发症发生情况、再造乳房效果以及供受区功能情况。结果共纳入9例女性乳腺癌患者,年龄27~45岁,平均37.4岁。手术方式包括6侧即刻乳房再造、5侧即刻-延期乳房再造和7侧延期乳房再造。下腹部皮瓣包括3种形式:带蒂腹直肌肌皮瓣4侧,游离携带部分腹直肌的腹直肌肌皮瓣5侧,游离腹壁下动脉穿支皮瓣9侧。游离股后内侧皮瓣包括4种形式:股薄肌肌皮瓣6侧,携带部分股薄肌的股薄肌肌皮瓣4侧,大收肌穿支皮瓣3侧,大收肌肌皮瓣5侧。再造一侧乳房的皮瓣组合方式包括4种:带蒂腹直肌肌皮瓣联合游离下腹部皮瓣4侧,双侧游离下腹部皮瓣3侧,双侧游离股后内侧皮瓣7侧,游离下腹部皮瓣联合游离股后内侧皮瓣4侧。所有皮瓣均顺利成活,未见明显并发症。随访12~18个月,平均14.7个月,再造乳房外形可,质地良好,基本对称;皮瓣供区及乳房受区仅遗留线性瘢痕,对大腿及腹壁功能无明显影响。结论根据供、受区血管情况,以及供区组织量、再造乳房所需组织量和乳房形态等因素,组合运用双侧下腹部皮瓣联合双侧游离股后内侧皮瓣移植,可以再造对称、美观的双侧乳房,但手术Objective:To investigate the strategies and technical points of combined bilateral lower abdominal flaps and bilateral free posteromedial thigh flaps transplantation for bilateral breast reconstruction.Methods:A retrospective analysis was conducted on the clinical data of patients who underwent bilateral breast reconstruction using bilateral free lower abdominal flaps combined with bilateral free posteromedial thigh flaps in the Department of Oncology Plastic Surgery at Hunan Cancer Hospital from August 2021 to April 2023.The key points for developing and flexibly adjusting the surgical strategy were based on the anatomic characteristics of blood vessels in recipient area and donor area.Accurate measurement of the volume,shape,and extent of skin defects of the bilateral breast was performed through physical examination and imaging studies to determine the size and shape of the required flaps.The number of perforating vessels and blood supply capacity of the lower abdomen and the posterior internal donor area of both thighs were detected by Doppler or color ultrasound to determine the free/pedicled lower abdomen flap.On this basis,the placement of the posteromedial thigh flaps and the vascular anastomotic position were determined.Postoperative follow-up included monitoring for complications,evaluating the outcomes of breast reconstruction,assessing patient satisfaction,and examining the functional status of both the donor and recipient areas.Results:A total of 9 female patients were included,aged from^(2)7 to 45 years old,with an average age of 37.4 years.Specifically,it included immediate breast reconstruction on 6 sides,immediate delayed breast reconstruction on 5 sides,and delayed breast reconstruction on 7 sides.There were three specific forms of lower abdominal skin flap,including pedicled rectus abdominis skin flap(4 sides),free rectus abdominis skin flap carrying partial rectus abdominis muscle(5 sides),and free inferior abdominal artery perforator skin flap(9 sides).There were four specific forms of free p

关 键 词：乳腺肿瘤 腹直肌肌皮瓣 腹壁下动脉穿支皮瓣 股后内侧皮瓣 乳房再造 

分 类 号：R65[医药卫生—外科学]