Sillah Nyama M, Shah Jinesh, Fukudome Eugene, Lin Samuel J
Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Plast Reconstr Surg Glob Open. 2016 Mar 17;4(3):e642. doi: 10.1097/GOX.0000000000000540. eCollection 2016 Mar.
Abdominal-based free flaps are commonly used for breast reconstruction, and the internal mammary or thoracodorsal vessels are typically used as recipient sites. Conversely, free tissue transfer is less commonly used for chest wall reconstruction in the setting of chest wall recurrence, in part, because of a paucity of recipient vessels. Here, we describe a case of a 68-year-old female smoker with metastatic breast cancer, who presented with a chest wall recurrence. There was a large area of chronic ulceration with foul smelling drainage, in addition to radiation-induced tissue injury, and palliative resection was performed. The area was reconstructed with a free transverse rectus abdominis myocutaneous flap using lumbar perforators as recipient vessels, because conventional recipient sites were unavailable because of scarring from radiation and residual tumor. This case demonstrates that uncommon recipient vessels such as lumbar perforators may allow for successful palliative chest wall reconstruction. We hypothesize that the tumor burden, previous surgeries, and radiation may have rendered the recipient field relatively ischemic, thereby inducing hypertrophy of the lumbar perforators, similar to a delay phenomenon.
腹部游离皮瓣常用于乳房重建，胸廓内血管或胸背血管通常用作受区。相反，在胸壁复发的情况下，游离组织移植较少用于胸壁重建，部分原因是受区血管不足。在此，我们描述一例68岁患转移性乳腺癌的吸烟女性患者，她出现了胸壁复发。除放射性组织损伤外，还有大面积慢性溃疡伴恶臭引流，遂行姑息性切除。由于放疗瘢痕和残留肿瘤，传统受区无法使用，因此该区域用游离腹直肌肌皮瓣以腰穿支作为受区血管进行重建。该病例表明，诸如腰穿支等不常见的受区血管可实现成功的胸壁姑息性重建。我们推测，肿瘤负荷、既往手术和放疗可能使受区相对缺血，从而导致腰穿支肥大，类似于延迟现象。
