Department of Plastic and Reconstructive Surgery, Brussels University Hospital, Vrij Universiteit Brussel (VUB), Brussels, Belgium.
Department of Plastic and Reconstructive Surgery, Brussels University Hospital, Vrij Universiteit Brussel (VUB), Brussels, Belgium.
J Plast Reconstr Aesthet Surg. 2014 Feb;67(2):219-25. doi: 10.1016/j.bjps.2013.10.047. Epub 2013 Nov 6.
Subcostal scars pose a risk of upper abdominal flap ischaemia when raising a free abdominal flap. The aim of this study was to describe a clinical approach to increase flap reliability and donor site healing in the presence of transverse abdominal scars while harvesting lower abdominal free flaps.
A total of 11 patients who had subcostal scars and one who had an extended subcostal scar (rooftop or chevron incision) underwent free abdominal flaps for breast reconstruction. Preoperative radiological imaging was used to evaluate the blood supply to the planned flaps. A classification of clinical approaches (I-IV) was used. When the cranial (the abdominal closure) flap width was equal to or greater than half length, a caudal (the breast) flap could safely be harvested (Type I); if not, the cranial flap was enlarged by more caudal flap planning (Type II), an oblique design of the free flap (Type III) or by lowering the free flap marking more distally (Type IV) with a sparing of the peri-umbilical perforators to preserve blood supply to the caudal (abdominal closure) flap.
Unilateral free deep inferior epigastric perforator (DIEP) and superficial inferior epigastric artery (SIEA) flaps were successfully harvested in eight and two cases, respectively. In two cases, a bipedicled DIEP/SIEA flap was harvested for unilateral breast reconstruction. Slight abdominal wound slough occurred in one patient; however, no ischaemia resulted in flaps or at donor sites.
Using a pragmatic approach to flap design, based on clinical classification, we have found that both flap and donor site morbidity can be avoided in patients who have previous upper abdominal scars.
IV, Therapeutic.
当提起游离腹部皮瓣时，肋缘下的瘢痕会增加上腹部皮瓣缺血的风险。本研究旨在描述一种临床方法，即在存在横向腹部瘢痕的情况下，提高游离下腹皮瓣的皮瓣可靠性和供区愈合率。
共有 11 名肋缘下有瘢痕的患者和 1 名肋缘下有延长性瘢痕（屋顶状或人字形切口）的患者接受了游离腹部皮瓣乳房重建。术前影像学检查用于评估计划皮瓣的血液供应。采用了一种临床方法的分类（I-IV 型）。当颅侧（腹部关闭）皮瓣的宽度等于或大于一半长度时，可以安全地采集尾侧（乳房）皮瓣（I 型）；否则，通过更靠近尾侧的皮瓣规划扩大颅侧皮瓣（II 型）、游离皮瓣的斜形设计（III 型）或通过更向下游离皮瓣标记来降低游离皮瓣标记（IV 型），保留脐周穿支以维持尾侧（腹部关闭）皮瓣的血液供应。
成功采集了 8 例单侧游离深下腹壁穿支皮瓣（DIEP）和 2 例浅层腹壁下动脉皮瓣（SIEA）。在 2 例患者中，采集了双蒂 DIEP/SIEA 皮瓣用于单侧乳房重建。1 例患者出现轻微的腹部伤口坏死；然而，皮瓣和供区均未发生缺血。
基于临床分类，采用一种实用的皮瓣设计方法，我们发现，对于既往有上腹部瘢痕的患者，可以避免皮瓣和供区的并发症。
IV，治疗性。
