Yan Xiao-qing, Yang Hong-yan, Zhao Yu-ming, You Lei, Xu Jun
Division of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Chin Med J (Engl). 2007 Mar 5;120(5):380-4.
In the past decade, there has been increasing breast reconstructions after mastectomy. The ideal material for reconstruction of a breast is fat and skin. The transverse rectus abdominis myocutaneous (TRAM) flap has been the gold standard for breast reconstruction until recently. Abdominal wall function is a major concern for plastic surgeons in breast reconstruction with TRAM flaps. The deep inferior epigastric perforator (DIEP) free flap spares the whole rectus abdominis muscle, includes skin and fat only, and therefore preserves adequate abdominal wall competence. The aim of this study was to summarize our experience in breast reconstruction with DIEP flap.
Between March 2000 and August 2005, a total of 43 breast reconstructions were performed on 40 patients by our surgeons using DIEP flap (3 patients had bilateral procedures), 14 of them were immediate surgeries and 26 were delayed. Abdominal function, satisfaction with the donor site and reconstructed breast, and the sensation recovery was assessed respectively during follow-up.
The mean age of the patients was 38.6 years (range, 28 - 50). The size of the flaps was 11 cm x 26 cm in average (height 10 - 12 cm, width 15 - 33 cm). The mean length of the vascular pedicles was 9.3 cm (range, 7 - 12). The patients were followed up for a mean of 16 months (range, 6 - 30 months). During the follow-up, 2 (5%) patients had total flap loss, 2 (5%) had partial necrosis, 4 (9%) had wound edge necrosis in the abdomen, and 1 had axillary seroma. None of the patients had hernia, and all of them were able to resume their daily activities after the operation. Patient satisfaction with the reconstructed breast rated high, 95% of the patients achieved spontaneous return of sensation in the reconstructed breast, but none of them had a sensation equivalent or approximate to the normal.
The DIEP flap has the same benefits as the TRAM flap without destroying the continuity of the rectus muscle. It can reduce donor-site morbidity and provide an aesthetic refinement in breast reconstruction.
在过去十年中，乳房切除术后进行乳房重建的情况日益增多。乳房重建的理想材料是脂肪和皮肤。直到最近，横行腹直肌肌皮瓣（TRAM瓣）一直是乳房重建的金标准。在使用TRAM瓣进行乳房重建时，腹壁功能是整形外科医生主要关注的问题。腹壁下深动脉穿支（DIEP）游离皮瓣保留了整个腹直肌，仅包含皮肤和脂肪，因此能保持足够的腹壁功能。本研究的目的是总结我们使用DIEP瓣进行乳房重建的经验。
2000年3月至2005年8月期间，我们的外科医生共为40例患者进行了43次乳房重建手术（3例患者接受了双侧手术），其中14例为即刻手术，26例为延迟手术。在随访期间分别评估腹壁功能、对供区和重建乳房的满意度以及感觉恢复情况。
患者的平均年龄为38.6岁（范围28 - 50岁）。皮瓣平均大小为11 cm×26 cm（高度10 - 12 cm，宽度15 - 33 cm）。血管蒂平均长度为9.3 cm（范围7 - 12 cm）。患者平均随访16个月（范围6 - 30个月）。随访期间，2例（5%）患者皮瓣完全坏死，2例（5%）部分坏死，4例（9%）腹部伤口边缘坏死，1例腋窝血清肿。所有患者均未发生疝气，且术后均能恢复日常活动。患者对重建乳房的满意度较高，95%的患者重建乳房感觉自发恢复，但均未恢复到正常或接近正常的感觉。
DIEP瓣具有与TRAM瓣相同的优点，且不破坏腹直肌的连续性。它可以降低供区并发症的发生率，并在乳房重建中提供美学上的改善。
