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腋窝推进缝合术以减少基于植入物的乳房重建术后畸形

Axillary Advancement Suture to Minimize Post-Implantation Deformity in Implant-Based Breast Reconstruction.

作者信息

Lee Jun Ho, Yeo Chi-Ho, Chung Kyu-Jin, Kim Taegon

机构信息

Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University Hospital, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Korea.

出版信息

Aesthetic Plast Surg. 2017 Oct;41(5):1007-1009. doi: 10.1007/s00266-017-0919-7. Epub 2017 Jun 29.

Abstract

Patients who have undergone implant-based breast reconstruction after skin-sparing mastectomy often complain about bulging on the upper flank or inferior axillary area. This is most likely because the subcutaneous tissue layer of the upper flank, which is continuous with the breast tissue, tends to show inferolateral drooping once the subcutaneous tissue becomes loose after eliminating the breast parenchyma. In addition, one of the weaknesses of implant surgery is that implants cannot completely replace the tissue removed during skin-sparing mastectomy (SSM). This leads to the formation of a depression and a stepping effect superior and lateral to the implant on both sides. Notably, because the pectoralis major muscle is quite thin, when there is a depression around the superolateral area of the implant, it acts as a band, which then leads to tissue bulging and serious aesthetic problems. Here, we describe a simple advancement suture technique that can be used to resolve these two aesthetic problems in direct-to-implant breast reconstruction. The advancement sutures are performed after the implant and drains are inserted following SSM and before closing the incision. First, the surgeon confirms the depression in the superolateral area of the implant insertion site by redraping a skin flap lateral to the margin. If a depression is suspected, the surgeon uses forceps to pull the subcutaneous tissue in the lateral flank pocket over to the lateral border of the pectoralis major muscle, superolateral to the implant. At this point, correction of the lateral flank bulging and depression on the superolateral border is verified. If the result is not satisfactory, the surgeon may attempt advancing the subcutaneous fat from different areas; the more posterior the tissue is advanced, the better it eliminates the lateral bulging and superolateral depression. However, too much advancement may cause extra tension, potentially resulting in tearing of the tissue. A round needle is used to suture two to three stitches, before completing wound closure. By performing this simple advancement suture, we were able to successfully minimize post-implantation deformity-bulging on the lateral flank and depression at the superolateral implant margin. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

摘要

保乳皮下乳房切除术后接受植入式乳房重建的患者经常抱怨上侧腹或腋下区域出现隆起。这很可能是因为与乳腺组织相连的上侧腹皮下组织层,一旦在切除乳腺实质后皮下组织变得松弛,就容易出现下外侧下垂。此外,植入手术的一个弱点是植入物不能完全替代保乳皮下乳房切除术(SSM)期间切除的组织。这会导致在植入物两侧的上方和外侧形成凹陷和阶梯效应。值得注意的是,由于胸大肌相当薄,当植入物上外侧区域周围出现凹陷时,它就像一条带子,进而导致组织隆起和严重的美学问题。在此,我们描述一种简单的推进缝合技术,可用于解决直接植入式乳房重建中的这两个美学问题。推进缝合在SSM后植入植入物和引流管后、关闭切口前进行。首先,外科医生通过重新覆盖边缘外侧的皮瓣来确认植入物插入部位上外侧区域的凹陷。如果怀疑有凹陷,外科医生用镊子将侧腹袋中的皮下组织拉到植入物上外侧的胸大肌外侧边缘。此时,可验证侧腹隆起和上外侧边缘凹陷的矫正情况。如果结果不令人满意,外科医生可以尝试从不同区域推进皮下脂肪;推进的组织越靠后,消除外侧隆起和上外侧凹陷的效果越好。然而,推进过多可能会导致额外的张力,潜在地导致组织撕裂。在完成伤口闭合前,用圆针缝合两到三针。通过进行这种简单的推进缝合,我们能够成功地将植入后畸形——侧腹隆起和植入物上外侧边缘凹陷降至最低。证据等级IV 本刊要求作者为每篇文章指定证据等级。有关这些循证医学评级的完整描述,请参阅目录或在线作者指南www.springer.com/00266

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