Veber M, Guerin A N, Faure C, Delay E, Mojallal A
Service de chirurgie plastique, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
Ann Chir Plast Esthet. 2012 Aug;57(4):366-72. doi: 10.1016/j.anplas.2012.03.001. Epub 2012 Apr 12.
The aim of this study is to assess our results of autologous breast reconstruction using a combined muscle sparing latissimus dorsi flap (MSLD) and fat tissue transfer.
A prospective study was performed on 20 patients over a period of 1 year. Three objective criteria were analyzed: morphometric, surgical procedure and postoperative latissimus dorsi function. A subjective assessment was done using a 4-level scale for patients' and surgeons' satisfaction.
Mean age of patients was of 45 ± 1.2 years. The average Body Mass Index (BMI) was 21.9 ± 2.2. The average weight of mastectomy specimen was 348.3 ± 135.6 g. The average duration of the surgical procedure was 149 ± 32.1 minutes. The average length of hospitalization was 4.5 ± 1.4 days. The average quantity of dorsal drainage during the hospitalization was 117.7 ± 41.5 cm(3), and a Visual Analog Scale (VAS) of pain of 2 ± 0.9 over 10. Patients from our series had 0.8 ± 0.9 dorsal punction per patient, with an average volume of seroma of 51.2 ± 70.8 cm(3). Fat grafting was used in every case with an average number of 1.2 ± 0.4 procedures per patient. The mean of injected volume was 250.1 ± 132.8 cm(3). No complications occurred in the postoperative period. There was no difference of latissimus dorsi functional assessment at 3 months and 1 year postoperative.
Combined MSLD and fat transfer is a reliable and an efficient technique for autologous breast reconstruction. The donor site morbidity is low, the postoperative recovery is fast and functional integrity of latissimus dorsi muscle is preserved in all cases. This technique can be used in immediate or delayed autologous breast reconstruction, and is particularly useful for bilateral breast reconstruction.
本研究的目的是评估我们使用保留肌肉的背阔肌肌皮瓣（MSLD）联合脂肪组织移植进行自体乳房重建的效果。
对20例患者进行了为期1年的前瞻性研究。分析了三个客观标准：形态学、手术过程和术后背阔肌功能。使用4级量表对患者和外科医生的满意度进行主观评估。
患者的平均年龄为45±1.2岁。平均体重指数（BMI）为21.9±2.2。乳房切除标本的平均重量为348.3±135.6克。手术的平均持续时间为149±32.1分钟。平均住院时间为4.5±1.4天。住院期间背部引流的平均量为117.7±41.5立方厘米，疼痛视觉模拟量表（VAS）评分为2±0.9（满分10分）。我们系列中的患者每人平均有0.8±0.9次背部穿刺，血清肿的平均体积为51.2±70.8立方厘米。每例均使用了脂肪移植，每位患者平均进行1.2±0.4次手术。注射体积的平均值为250.1±132.8立方厘米。术后无并发症发生。术后3个月和1年时背阔肌功能评估无差异。
MSLD联合脂肪移植是一种可靠且有效的自体乳房重建技术。供区并发症发生率低，术后恢复快，所有病例中背阔肌的功能完整性均得以保留。该技术可用于即刻或延期自体乳房重建，尤其适用于双侧乳房重建。
