Reissis Dimitris, Butler Daniel P, Henry Francis P, Wood Simon H
Department of Plastic and Reconstructive Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Foundation Trust, London W6 8RF, United Kingdom.
Microsurgery. 2018 Jul;38(5):563-566. doi: 10.1002/micr.30292. Epub 2018 Jan 8.
Surgeons performing free flap breast reconstruction need to have a range of techniques in their armamentarium to successfully salvage cases of flap failure. We present a case of 47-year-old patient who suffered near-total right breast deep inferior epigastric perforator (DIEP) flap failure 3 days post-bilateral immediate breast reconstruction with DIEP flaps. At debridement, the DIEP pedicle was noted to be patent with preserved perfusion to a small segment of tissue around the origin of the pedicle. This tissue and the DIEP pedicle itself were therefore preserved to facilitate subsequent breast reconstruction using stacked transverse upper gracilis flaps anastomosed end-to-end to the original DIEP pedicle. Post-operatively, both flaps remained viable with no further complications and symmetrical aesthetic result maintained at 2 months follow-up post-salvage procedure. This case emphasizes the importance of exercising caution during initial debridement for free flap failure to preserve viable tissue in the flap and pedicle, particularly in circumstances where vascular flow in the pedicle is maintained, to facilitate successful salvage reconstruction.
进行游离皮瓣乳房重建的外科医生需要掌握一系列技术，以便在皮瓣失败的情况下成功挽救病例。我们报告一例47岁患者，在双侧即刻乳房重建术中采用腹壁下深动脉穿支（DIEP）皮瓣，术后3天右侧DIEP皮瓣几乎完全失败。清创时，发现DIEP蒂通畅，蒂部起源周围一小段组织灌注良好。因此保留了该组织和DIEP蒂本身，以便随后使用端端吻合至原DIEP蒂的堆叠横行股薄肌皮瓣进行乳房重建。术后，两个皮瓣均存活，无进一步并发症，在挽救手术后2个月的随访中维持了对称的美学效果。该病例强调了在游离皮瓣失败的初次清创过程中谨慎操作以保留皮瓣和蒂部存活组织的重要性，特别是在蒂部血管血流得以维持的情况下，以促进成功的挽救性重建。
