de Runz A, Boccara D, Bekara F, Chaouat M, Mimoun M
Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
Service de chirurgie plastique, reconstructrice, esthétique et traitement chirurgical des brûlés, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
Ann Chir Plast Esthet. 2017 Feb;62(1):23-30. doi: 10.1016/j.anplas.2016.07.023. Epub 2016 Sep 7.
Delayed breast reconstruction with tissue expansion may be risky after radiotherapy, due to the poor skin quality. To permit the use of the tissue expansion procedure, we propose a scarless latissimus dorsi flap to bring tissue trophicity, by a healthy vascularized muscular interface with no donor scar and no patch effect. The objective of this study is to assess the outcome of the tissue expansion technique with scarless latissimus dorsi flap after post-mastectomy radiotherapy.
All the patients who had benefited of a delayed breast reconstruction after radiotherapy using tissue expansion technique with scarless latissimus dorsi flap, between January 2000 and January 2013, were reviewed. The exclusion criteria were: prior breast reconstruction, or interruption of breast reconstruction procedure due to active metastatic disease requiring ongoing oncological treatment. The complications were identified: failures of reconstruction, implant exposure, wound dehiscence, capsular contracture, deflation of implant, hematoma, infection, and skin necrosis.
One hundred and twenty-two breasts were reviewed. The average time between the flap and the expander intervention was: 194±114 SD (28-1051) days. The mean volume of inserted expander was 633±111 SD (350-1100) mL and the mean inflation volume was 578±190 SD (170-1160) mL. The average time between insertion of the expander and insertion of the permanent implant was 132±76 SD (49-683) days. The mean inflation of the implant volume was 368±105 SD (130-620) mL. Forty patients developed at least one complication. The most common complication was the appearance of a capsular contracture requiring a capsulectomy: 11 (9.2%) with permanent implants and 6 (4.9%) with expander. Deflation of implants occurred with six permanent implants and with one expander. There were 3 breast reconstructions failures (two infections and one exposure of implants).
This procedure offers the advantages that there is no unattractive scar, and that there are low rates of exposure or failed reconstruction.
由于放疗后皮肤质量较差，采用组织扩张术进行延迟性乳房重建可能存在风险。为了能够使用组织扩张术，我们提出一种无瘢痕背阔肌皮瓣，通过健康的带血管肌肉界面来改善组织营养状况，且无供区瘢痕和补片效应。本研究的目的是评估乳房切除术后放疗后采用无瘢痕背阔肌皮瓣进行组织扩张技术的效果。
回顾了2000年1月至2013年1月间所有采用无瘢痕背阔肌皮瓣组织扩张技术进行放疗后延迟性乳房重建的患者。排除标准为：既往有乳房重建史，或因需要持续进行肿瘤治疗的活动性转移性疾病而中断乳房重建手术。确定并发症情况：重建失败、植入物外露、伤口裂开、包膜挛缩、植入物瘪陷、血肿、感染和皮肤坏死。
共回顾了122例乳房。皮瓣与扩张器干预之间的平均时间为：194±114标准差（28 - 1051）天。插入扩张器的平均体积为633±111标准差（350 - 1100）mL，平均注水体积为578±190标准差（170 - 1160）mL。扩张器插入与永久性植入物插入之间的平均时间为132±76标准差（49 - 683）天。植入物体积的平均注水量为368±10标准差（130 - 620）mL。40例患者出现至少一种并发症。最常见的并发症是出现需要进行包膜切除术的包膜挛缩：永久性植入物患者中有11例（9.2%），扩张器患者中有6例（4.9%）。6例永久性植入物和1例扩张器出现植入物瘪陷。有3例乳房重建失败（2例感染和1例植入物外露）。
该手术具有无明显瘢痕、植入物外露或重建失败率低的优点。
