Lee Taik Jong, Noh Hyung Joo, Kim Eun Key, Eom Jin Sup
Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Arch Plast Surg. 2012 Jul;39(4):384-9. doi: 10.5999/aps.2012.39.4.384. Epub 2012 Jul 13.
Numerous procedures are available for nipple reconstruction without a single gold standard. This study presents a method for reducing donor-site morbidity in nipple reconstruction using a composite nipple graft after transverse rectus abdominis musculocutaneous flap breast reconstruction.
Thirty-five patients who underwent nipple reconstruction using a composite nipple graft technique between July of 2001 and December of 2009 were enrolled in this study. To reduce the donor site morbidity, the superior or superior-medial half dome harvesting technique was applied preserving the lateral cutaneous branch of the fourth intercostal nerves. The patients were asked to complete a previously validated survey to rate the color and projection of both nipples, along with the sensation and contractility of the donor nipple; and whether, in retrospect, they would undergo the procedure again. To compare projection, we performed a retrospective chart review of all the identifiable patients who underwent nipple reconstruction using the modified top hat flap technique by the same surgeon and during the same period.
Thirty-five patients were identified who underwent nipple reconstruction using a composite nipple graft. Of those, 29 patients (82.9%) responded to the survey. Overall, we received favorable responses to the donor site morbidity. Projection at postoperative 6 months and 1 year was compared with the immediate postoperative results, as well as with the results of nipples reconstructed using the modified top hat flap.
The technique used to harvest donor tissue is important. Preserving innervation of the nipple while harvesting can reduce donor site morbidity.
目前有多种乳头重建手术方法，但尚无单一的金标准。本研究介绍了一种在腹直肌肌皮瓣乳房重建术后使用复合乳头移植物进行乳头重建以降低供区并发症的方法。
选取2001年7月至2009年12月间采用复合乳头移植物技术进行乳头重建的35例患者纳入本研究。为降低供区并发症，采用上半或上内侧半穹窿采集技术，保留第四肋间神经的外侧皮支。要求患者完成一份先前验证过的调查问卷，对双侧乳头的颜色和突出度、供区乳头的感觉和收缩性进行评分；并回顾性询问他们是否会再次接受该手术。为比较突出度，我们对同一外科医生在同一时期采用改良礼帽皮瓣技术进行乳头重建的所有可识别患者进行了回顾性病历审查。
共识别出35例采用复合乳头移植物进行乳头重建的患者。其中，29例患者（82.9%）回复了调查问卷。总体而言，我们收到了关于供区并发症的良好反馈。将术后6个月和1年时的突出度与术后即刻结果以及采用改良礼帽皮瓣重建乳头的结果进行了比较。
采集供区组织的技术很重要。采集时保留乳头的神经支配可降低供区并发症。
