制备不同形式游离腹直肌皮瓣联合游离腹壁浅动脉穿支皮瓣再造单侧乳房的策略和技术要点  

Strategy and technical points of harvesting different forms of free rectus abdominis muscle flap combined with free superficial inferior epigastric artery perforator flap for unilateral breast reconstruction

作　　者：郭如琪 张天怡 宋达疆 王志远 刘旭 李赞 Guo Ruqi;Zhang Tianyi;Song Dajiang;Wang Zhiyuan;Liu Xu;Li Zan(Department of Breast Surgery,Changzhi People's Hospital,Changzhi Medical College,Changzhi 046000,China;Department of Breast Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 410008,China;Department of Oncology Plastic Surgery,Hunan Province Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410008,China;Ultrasound Diagnosis Center,Hunan Province Cancer Hospital and Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University,Changsha 410008,China)

机构地区：[1]长治医学院附属长治市人民医院乳腺外科,长治046000 [2]哈尔滨医科大学附属第一医院乳腺外科,哈尔滨150001 [3]中南大学湘雅医学院附属肿瘤医院、湖南省肿瘤医院肿瘤整形外科,长沙410008 [4]中南大学湘雅医学院附属肿瘤医院、湖南省肿瘤医院超声诊断中心,长沙410008

出　　处：《中华医学美学美容杂志》2025年第2期93-98,共6页Chinese Journal of Medical Aesthetics and Cosmetology

基　　金：湖南省卫生健康委科研计划课题(202209024847)。

摘　　要：游离腹壁下动脉穿支皮瓣是目前备受推崇的自体乳房再造技术。在临床工作中,下腹部血管及周围组织结构的解剖情况并不一定适合制备穿支皮瓣。很多情况下需要携带更多的腹直肌肌袖以确保穿支血管对皮瓣的可靠供血。无论何种形式的腹直肌皮瓣都必须要切开前鞘和完成腹直肌内的血管蒂分离操作,与之相比较,腹壁浅动脉穿支皮瓣对供区的损伤大大减小,但是腹壁浅动静脉存在解剖情况不恒定的缺点,增加了手术的不确定性。本文根据临床实际所见详细制定了较为完善的临床策略流程,以游离腹直肌皮瓣的不同形式为主,在客观条件满足的情况下额外制备游离腹壁浅动脉穿支皮瓣,目的是在确保下腹部皮瓣血运可靠的基础上减少供区损伤,降低手术难度。The free inferior epigastric artery perforator flap is currently a highly regarded autologous breast reconstruction technique.However,in clinical practice,the anatomical characteristics of the lower abdominal vasculature and surrounding tissue structures do not always permit ideal perforator flap harvesting.In many cases,it becomes necessary to preserve a larger rectus abdominis muscle cuff to ensure reliable blood supply to the flap through the perforating vessels.Compared with various forms of rectus abdominis myocutaneous flaps that all require incision of the anterior sheath and intramuscular vascular pedicle dissection,the superficial inferior epigastric artery(SIEA)perforator flap significantly reduces donor-site morbidity.Nevertheless,the anatomical variability of the superficial inferior epigastric vessels increases surgical uncertainty.Based on clinical observations,this study establishes a comprehensive clinical strategy algorithm.Primarily focusing on different configurations of free rectus abdominis flaps,it incorporates additional preparation of free SIEA perforator flaps when anatomical conditions permit.The objectives are to ensure reliable perfusion of the lower abdominal flap while minimizing donor-site damage and reducing surgical complexity.

关 键 词：乳腺肿瘤 腹直肌皮瓣 腹壁浅动脉穿支皮瓣 乳房再造 

分 类 号：R737.9[医药卫生—肿瘤]