Department of Plastic and Reconstructive Surgery and NSW Breast Cancer Institute, University of Sydney Westmead Hospital, Westmead, New South Wales, Australia.
Microsurgery. 2010;30(2):151-5. doi: 10.1002/micr.20705.
Breast reconstruction using a free transverse rectus abdominis myocutaneous flap or a deep inferior epigastric perforator (DIEP) flap is a challenge in patients with a vertical midline abdominal scar due to the poor perfusion of the lower abdominal skin ellipse across the midline. In such patients, only one half of the abdominal skin ellipse can be used with certainty, and this limits the amount of tissue available for reconstructing the breast. Two cases of breast reconstruction in patients with a lower midline abdominal scar are presented using the DIEP flap, in which the poor perfusion across the midline scar was overcome by a technique of crossover anastomoses between the two deep inferior epigastric pedicles. Reliable perfusion of the entire lower abdominal skin ellipse was achieved. This crossover anastomoses technique overcomes the poor perfusion imposed by the vertical midline abdominal scar and enables DIEP flap breast reconstruction to be offered to women with midline abdominal scars.
利用游离横形腹直肌肌皮瓣或腹壁下动脉穿支皮瓣（DIEP 皮瓣）进行乳房重建对于存在垂直腹部正中线瘢痕的患者是一项挑战，这是因为中下腹部皮肤在正中线处的血供较差。对于此类患者，只能确定使用腹部皮瓣的一半，这限制了用于乳房重建的组织量。本文介绍了 2 例采用 DIEP 皮瓣进行乳房重建的病例，通过在两条腹壁下血管蒂之间进行交叉吻合的技术克服了跨越正中线瘢痕的血供不良问题，从而实现了整个下腹部皮肤皮瓣的可靠血供。这种交叉吻合技术克服了垂直腹部正中线瘢痕造成的血供不良，使得 DIEP 皮瓣乳房重建能够应用于存在腹部正中线瘢痕的女性。
