Kind Gabriel M, Foster Robert D
Department of Plastic Surgery, Davies Campus of California-Pacific Medical Center, San Francisco, California 94114, USA.
Ann Plast Surg. 2008 Nov;61(5):513-20. doi: 10.1097/SAP.0b013e318168db64.
Many patients who present for autogenous breast reconstruction are not suitable candidates for abdominal wall flaps, either because of previous abdominal surgery (most commonly transverse rectus abdominis myocutaneous flap for prior breast reconstruction) or because of the lack of enough adipose tissue. Another donor site option is the medial thigh that has more recently been recognized as a source of tissue for breast reconstruction. Prior reports have described the harvest of a gracilis myocutaneous flap through a transverse incision. From August 2004 to April 2007, 12 patients underwent autogenous breast reconstruction of 15 breasts with the longitudinal gracilis myocutaneous microvascular flap. The patients' ages ranged from 41 to 60 years (average, 48 years). In all patients the longitudinal gracilis flap was chosen because of a desire for autogenous reconstruction and a lack of available abdominal wall tissue. Mean follow-up of the 12 patients was 16.8 months (range, 5-36 months). There was no microvascular thrombosis or free-flap failure in this series. Donor sites were well tolerated by all patients. Three patients underwent suction-assisted lipectomy of 5 donor site areas to improve contour and/or symmetry. The longitudinal gracilis myocutaneous flap is a useful alternative for breast reconstruction in properly selected patients.
许多前来接受自体乳房重建的患者并不适合采用腹壁皮瓣，这要么是因为既往有腹部手术史（最常见的是之前因乳房重建采用过腹直肌肌皮瓣），要么是因为缺乏足够的脂肪组织。另一种供区选择是大腿内侧，其最近已被认可为乳房重建的组织来源。既往报告描述了通过横向切口切取股薄肌肌皮瓣。2004年8月至2007年4月，12例患者采用纵向股薄肌肌皮微血管皮瓣对15个乳房进行了自体乳房重建。患者年龄在41至60岁之间（平均48岁）。所有患者均因希望进行自体重建且腹壁组织不可用而选择了纵向股薄肌皮瓣。12例患者的平均随访时间为16.8个月（范围5至36个月）。本系列中未发生微血管血栓形成或游离皮瓣坏死。所有患者对供区的耐受性良好。3例患者对5个供区进行了吸脂辅助脂肪抽吸术，以改善外形和/或对称性。对于经过适当选择的患者，纵向股薄肌肌皮瓣是乳房重建的一种有用的替代方法。
