Robustillo Manuel, Pont Luis Parra, Pafitanis Georgios, Ciudad Pedro, Grandes Daniel, Iglesias Israel
Department of Plastic and Reconstructive Surgery, Hospital 12 de Octubre, Madrid, Spain.
Department of Plastic and Reconstructive Surgery, Queen Mary University of London, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom.
Indian J Plast Surg. 2018 Jan-Apr;51(1):89-92. doi: 10.4103/ijps.IJPS_185_17.
DIEP flap has become the gold standard method for patients undergoing autologous breast reconstruction; however, previous surgery or scars in the abdominal area have been considered a relative contraindication for the use of abdominal tissue. Longitudinal midline abdominal scars may be specially problematic because of the poor midline crossover of blood and the high risk of necrosis of the distal flap. Patients with small breast may be easily reconstructed with hemi-DIEP flap; however, patients with large breast need more tissue available. Our aim is to report a modification of a 'fleur-de-lis pattern' for a breast reconstruction in a patient with previous abdominal surgery and large breast. The post-operative course was uneventful, flap did not show blood supply compromise, volume and symmetry are preserved after 6 months post-operative and donor site morbidity has not been observed. This modification may be very useful to avoid complications related to poor blood supply associated with scar tissues. Careful pre-operative planning and the transfer of only well-vascularised tissue are essential for a successful reconstruction.
腹壁下动脉穿支皮瓣已成为自体乳房重建患者的金标准术式；然而，既往腹部手术或瘢痕一直被视为使用腹部组织的相对禁忌证。腹部正中纵行瘢痕可能特别成问题，因为中线血供交叉不佳且远端皮瓣坏死风险高。乳房较小的患者采用半腹壁下动脉穿支皮瓣可能容易重建；然而，乳房较大的患者需要更多可用组织。我们的目的是报告一种针对既往有腹部手术史且乳房较大患者的乳房重建的“百合花图案”改良术式。术后过程顺利，皮瓣未出现血供受损情况，术后6个月时乳房体积和对称性得以保留，且未观察到供区并发症。这种改良对于避免与瘢痕组织相关的血供不良所致并发症可能非常有用。仔细的术前规划以及仅转移血供良好的组织对于成功重建至关重要。
