Sjøberg Thomas, de Weerd Louis
Department of Plastic and Reconstructive Surgery, University Hospital of North Norway, Tromsø, Norway; and Medical Imaging Research Group, Institute of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.
Plast Reconstr Surg Glob Open. 2018 Jan 12;6(1):e1562. doi: 10.1097/GOX.0000000000001562. eCollection 2018 Jan.
Previous surgery or slim body configuration can limit the size of the available abdominal flap in autologous breast reconstruction. However, redundant skin and subcutaneous tissue lateral to the mastectomy site can be utilized as the pedicled lateral intercostal artery perforator (LICAP) flap. This study evaluates the combination of a free abdominal flap and a pedicled LICAP flap to achieve increased breast size and improved cosmetic outcome.
Patients undergoing secondary autologous breast reconstruction were included in a prospective study. The combination with a LICAP flap was used for women with insufficient abdominal flap tissue in relation to the desired breast size. The authors also assessed their modification of the original lateral thoracodorsal flap design to improve the aesthetic outcome.
In 109 patients, 121 free abdominal flaps were performed. The combination with a pedicled LICAP flap was used in 82 free abdominal flap reconstructions (68%). The LICAP flap provided additional volume and resulted in better projection and ptosis of the neo-mamma. The overall complication rate for the LICAP flaps was 26 %; all minor complications. Despite combining flaps, the majority of patients needed additional surgery to improve breast symmetry. Breast reduction of the native breast was the most common symmetrizing procedure.
In selected patients with insufficient abdominal flap tissue, a combination of a free abdominal flap and a pedicled LICAP flap is a valuable option to increase breast size and cosmetic outcome. Additional symmetrizing surgery might still be necessary.
既往手术史或体型消瘦可能会限制自体乳房重建中可用腹部皮瓣的大小。然而，乳房切除部位外侧多余的皮肤和皮下组织可被用作带蒂肋间外侧动脉穿支（LICAP）皮瓣。本研究评估游离腹部皮瓣与带蒂LICAP皮瓣联合使用以增加乳房体积并改善美容效果。
接受二期自体乳房重建的患者纳入一项前瞻性研究。对于腹部皮瓣组织量相对于预期乳房大小不足的女性，采用与LICAP皮瓣联合的方法。作者还评估了他们对原始胸背外侧皮瓣设计的改良以改善美学效果。
109例患者中，共进行了121次游离腹部皮瓣手术。82例游离腹部皮瓣重建（68%）采用了与带蒂LICAP皮瓣联合的方法。LICAP皮瓣增加了乳房体积，使新乳房的凸度和下垂度更佳。LICAP皮瓣的总体并发症发生率为26%；均为轻微并发症。尽管联合了皮瓣，但大多数患者仍需要额外手术以改善乳房对称性。对患侧乳房进行缩乳术是最常见的对称化手术。
对于腹部皮瓣组织量不足的特定患者，游离腹部皮瓣与带蒂LICAP皮瓣联合使用是增加乳房体积和改善美容效果的一种有价值的选择。可能仍需要额外的对称化手术。
