股外侧穿支皮瓣游离移植乳房再造术：138 例皮瓣前瞻性分析。
The Lateral Thigh Perforator Flap for Autologous Breast Reconstruction: A Prospective Analysis of 138 Flaps.
机构信息
Maastricht, The Netherlands; Temple, Texas; New York, N.Y.; and New Orleans, La.
From the Departments of Plastic, Reconstructive, and Hand Surgery, Anatomy and Embryology, Radiology, GROW - School for Oncology and Developmental Biology, and NUTRIM - School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center; the Division of Plastic Surgery, Baylor Scott & White Health; the Department of Plastic Surgery, New York University Langone Medical Center; and the Division of Plastic Surgery, Louisiana State University Health Sciences Center.
出版信息
Plast Reconstr Surg. 2018 Feb;141(2):257-268. doi: 10.1097/PRS.0000000000004072.
BACKGROUND
The septocutaneous tensor fasciae latae or lateral thigh perforator flap was previously introduced by the authors' group as an alternative flap for autologous breast reconstruction when the abdomen is not suitable as a donor site. The authors analyzed their experience with the lateral thigh perforator flap and present the surgical refinements that were introduced.
METHODS
A prospective study was conducted of all lateral thigh perforator flap breast reconstructions performed since September of 2012. Patient demographics, operative details, complications, and flap reexplorations were recorded. Preoperative imaging with magnetic resonance angiography was performed in all patients. Surgical refinements introduced during this study included limitation of the flap width and the use of quilting sutures at the donor site.
RESULTS
A total of 138 lateral thigh perforator flap breast reconstructions were performed in 86 consecutive patients. Median operative times were 277 minutes (range, 196 to 561 minutes) for unilateral procedures and 451 minutes (range, 335 to 710 minutes) for bilateral. Median flap weight was 348 g (range, 175 to 814 g). Two total flap losses (1.4 percent) were recorded, and 11 flaps (8.0 percent) required reexploration, which resulted in viable flaps. The incidence of donor-site complications was reduced significantly after the surgical refinements were introduced. Wound problems decreased from 40.0 percent to 6.3 percent, seroma decreased from 25.0 percent to 9.5 percent, and infection decreased from 27.5 percent to 9.5 percent.
CONCLUSIONS
The lateral thigh perforator flap is an excellent option for autologous breast reconstruction, with minimal recipient-site complications. The surgical refinements resulted in a significant reduction of donor-site complications. Therefore, the lateral thigh perforator flap is currently the authors' second choice after the deep inferior epigastric artery perforator flap.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
背景
先前，作者团队介绍了一种股外侧穿支皮瓣（tensor fasciae latae 或 lateral thigh perforator flap），可作为腹部不适合作为供区时自体乳房重建的替代皮瓣。作者分析了他们使用股外侧穿支皮瓣的经验，并介绍了引入的手术改进方法。
方法
对 2012 年 9 月以来所有进行的股外侧穿支皮瓣乳房重建患者进行前瞻性研究。记录患者人口统计学资料、手术细节、并发症和皮瓣再次探查情况。所有患者均行术前磁共振血管造影成像。本研究中引入的手术改进包括限制皮瓣的宽度和在供区使用缝合线。
结果
86 例连续患者共行 138 例股外侧穿支皮瓣乳房重建。单侧手术的中位手术时间为 277 分钟（范围 196 至 561 分钟），双侧手术的中位手术时间为 451 分钟（范围 335 至 710 分钟）。中位皮瓣重量为 348 克（范围 175 至 814 克）。记录到 2 例（1.4%）全层皮瓣坏死，11 例（8.0%）皮瓣需要再次探查，结果为皮瓣存活。引入手术改进后，供区并发症的发生率显著降低。伤口问题从 40.0%降至 6.3%，血清肿从 25.0%降至 9.5%，感染从 27.5%降至 9.5%。
结论
股外侧穿支皮瓣是自体乳房重建的绝佳选择，其受区并发症发生率低。手术改进后显著降低了供区并发症的发生率。因此，股外侧穿支皮瓣目前是作者在深下动脉穿支皮瓣之后的第二选择。
临床问题/证据水平：治疗性，IV 级。
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