Chan Rodney K, Przylecki Wojitec, Guo Lifei, Caterson Stephanie A
Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA 02445, USA.
Eplasty. 2010 Apr 30;10:e32.
Deep inferior epigastric artery perforator (DIEP) flap is an excellent option for breast reconstruction in young and active patients who have a history of chest wall radiation. One drawback, however, is that the entire capacity of abdominal pannus cannot be reliably transferred on a single pedicle. The purpose of this case report is to demonstrate a method of maximizing the volume of reconstruction with a dual-pedicled DIEP flap.
A case is reported in which both antegrade and retrograde internal mammary vessels were used as recipient sites for a dual-pedicled, folded, stacked DIEP flap.
Good flows were observed in both sets of recipient vessels intraoperatively. Postoperative imaging revealed patent vascular anastomoses of both pedicles. At 1-year follow-up, there was no evidence of fat necrosis and a satisfactory aesthetic outcome was achieved.
To maximize the volume of the reconstructed breast, the entire abdominal pannus can be utilized. The retrograde limb of internal mammary vessels can act as the recipient site for the second pedicle, minimizing donor site morbidity.
对于有胸壁放疗史的年轻且活跃的患者，腹壁下深动脉穿支（DIEP）皮瓣是乳房重建的极佳选择。然而，一个缺点是腹部赘肉的全部容量无法通过单一蒂可靠地转移。本病例报告的目的是展示一种使用双蒂DIEP皮瓣最大化重建体积的方法。
报告一例病例，其中顺行和逆行胸廓内血管均用作双蒂、折叠、堆叠DIEP皮瓣的受区。
术中观察到两组受区血管均有良好血流。术后影像学检查显示两个蒂的血管吻合均通畅。随访1年时，没有脂肪坏死的迹象，获得了满意的美学效果。
为了最大化重建乳房的体积，可以利用整个腹部赘肉。胸廓内血管的逆行分支可作为第二个蒂的受区，将供区并发症降至最低。
