Teotia Sumeet S, Cho Min-Jeong, Haddock Nicholas T
Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
Plast Reconstr Surg Glob Open. 2018 Sep 5;6(9):e1837. doi: 10.1097/GOX.0000000000001837. eCollection 2018 Sep.
Over the years, the choice of recipient vessels for free flap autologous breast reconstruction has shifted from the thoracodorsal to the internal mammary vessels due to ease of flap inset and predictability of anatomy. However, thoracodorsal vessels are still great recipient vessels, and can be useful, especially in the previously failed or staged autologous breast reconstruction. In this study, we present our experience using thoracodorsal or serratus vessels for profunda artery perforator flaps.
Of the 792 autologous free flap breast reconstruction performed, we identified 12 patients (21 flaps) who underwent reconstruction using thoracodorsal or serratus vessels from 2012 to 2017. Flap, patient characteristics, and demographic data and perioperative details were collected.
Twenty-one flaps were used to reconstruct 14 breasts in 12 patients. The mean age of patients was 49.6 years old (range, 42-54), the mean flap weight was 354.7 g (range, 170-540 g), the mean body mass index was 28 (range, 23.2-34.4), and the average operative time was 496.1 minutes (266-680). Majority of these patients underwent additional staged free flap reconstruction (following previous deep inferior epigastric perforator flaps) for severe breast contour defects (58%) and for failed previous breast reconstruction (42%). The anastomosis was performed using thoracodorsal (43%), serratus (43%), and profunda artery perforator side branch (14%) vessels.
Determining appropriate flap and recipient vessels in a previously failed or staged breast reconstruction is very challenging. Thoracodorsal and serratus vessels are excellent recipient vessels in patients who already have exhausted internal mammary vessels for previous breast reconstruction.
多年来，由于皮瓣植入操作简便且解剖结构可预测，游离皮瓣自体乳房重建的受区血管选择已从胸背血管转向胸廓内血管。然而，胸背血管仍是很好的受区血管，且可能有用，特别是在既往自体乳房重建失败或分期进行的情况下。在本研究中，我们介绍了使用胸背或锯肌血管进行旋股深动脉穿支皮瓣的经验。
在792例游离皮瓣自体乳房重建手术中，我们确定了12例患者（21个皮瓣），他们在2012年至2017年期间使用胸背或锯肌血管进行了重建。收集了皮瓣、患者特征、人口统计学数据及围手术期细节。
21个皮瓣用于为12例患者重建14个乳房。患者的平均年龄为49.6岁（范围42 - 54岁），皮瓣平均重量为354.7 g（范围170 - 540 g），平均体重指数为28（范围23.2 - 34.4），平均手术时间为496.1分钟（266 - 680分钟）。这些患者中的大多数因严重乳房外形缺陷（58%）和既往乳房重建失败（42%）接受了额外的分期游离皮瓣重建（在先前的腹壁下深动脉穿支皮瓣之后）。吻合使用胸背血管（43%）、锯肌血管（43%）和旋股深动脉穿支侧支血管（14%）进行。
在既往失败或分期进行的乳房重建中确定合适的皮瓣和受区血管极具挑战性。对于既往乳房重建已用尽胸廓内血管的患者，胸背和锯肌血管是优秀的受区血管。
