From the Department of Plastic, Reconstructive and Hand Surgery, and the GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center; the Department of Plastic Surgery, New York Eye and Ear Infirmary at Mt. Sinai; the Division of Plastic Surgery, Northern Westchester Hospital; the Division of Plastic Surgery, Louisiana State University Health Sciences Center; and the Department of Plastic Surgery, Hackensack University Medical Center.
Plast Reconstr Surg. 2018 Dec;142(6):1424-1434. doi: 10.1097/PRS.0000000000005058.
Options for bilateral autologous breast reconstruction in thin women are limited. The aim of this study was to introduce a novel approach to increase abdominal flap volume with the stacked hemiabdominal extended perforator (SHAEP) flap. The authors describe the surgical technique and analyze their results.
A retrospective study was conducted of all SHAEP flap breast reconstructions performed since February of 2014. Patient demographics, operative details, complications, and flap reexplorations were recorded. The bipedicled hemiabdominal flap was designed as a combination of the deep inferior epigastric artery perforator (DIEP) and a second, more lateral pedicle: the deep or superficial circumflex iliac perforator vessels, the superficial inferior epigastric artery, or a lumbar artery or intercostal perforator.
A total of 90 SHAEP flap breast reconstructions were performed in 49 consecutive patients. Median operative time was 500 minutes (range, 405 to 797 minutes). Median hemiabdominal flap weight that was used for reconstruction was 598 g (range, 160 to 1389 g). No total flap losses were recorded. Recipient-site complications included partial flap loss (2.2 percent), hematoma (3.3 percent), fat necrosis (2.2 percent), and wound problems (4.4 percent). Minor donor-site complications occurred in five patients (10.2 percent). Most flaps were harvested on a combination of the DIEP and deep circumflex iliac artery vessels.
This study demonstrated that the SHAEP flap is an excellent option for bilateral autologous breast reconstruction in women who require significant breast volume but have insufficient abdominal tissue for a bilateral DIEP flap. The bipedicled SHAEP flap allows for enhanced flap perfusion, increased volume, and abdominal contour improvement using a single abdominal donor site.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
对于身材偏瘦的女性来说，双侧自体乳房重建的选择有限。本研究旨在介绍一种增加堆叠式半侧腹内扩延穿支皮瓣（SHAEP）皮瓣体积的新方法。作者描述了手术技术并分析了他们的结果。
对自 2014 年 2 月以来所有接受 SHAEP 皮瓣乳房重建的患者进行了回顾性研究。记录患者的人口统计学资料、手术细节、并发症和皮瓣再次探查情况。双蒂半侧腹皮瓣设计为腹壁下动脉穿支（DIEP）和第二个更外侧蒂的结合：旋髂深血管、旋髂浅血管、腹壁下动脉或腰动脉或肋间穿支。
49 例连续患者共进行了 90 例 SHAEP 皮瓣乳房重建。中位手术时间为 500 分钟（范围为 405 至 797 分钟）。用于重建的中位半侧腹皮瓣重量为 598 克（范围为 160 至 1389 克）。未记录到总皮瓣丢失。受区并发症包括部分皮瓣坏死（2.2％）、血肿（3.3％）、脂肪坏死（2.2％）和伤口问题（4.4％）。5 例患者出现轻微供区并发症（10.2％）。大多数皮瓣是在 DIEP 和旋髂深血管的组合下采集的。
本研究表明，对于需要大量乳房体积但双侧 DIEP 皮瓣供区组织不足的女性，SHAEP 皮瓣是双侧自体乳房重建的绝佳选择。双蒂 SHAEP 皮瓣允许通过单个腹部供区使用增强的皮瓣灌注、增加的体积和腹部轮廓改善。
临床问题/证据水平：治疗，IV。
