Li Guangxue, Mu Lan, Yang Kai, Peng Zhe, Liu Yan, Bi Ye, Zhu Yi, Wang Cai, Wang Yi, Zang Huiran, Cao Saisai, Zhang Peiyang
Department of Plastic and Reconstructive Surgery, Peking University People's Hospital, Beijing, 100044, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Jan 15;33(1):70-74. doi: 10.7507/1002-1892.201807043.
To explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction.
Between March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Unilateral breast reconstruction were performed for 8 patients with unilateral pedicle transverse rectus abdominis musculocutaneous (TRAM) flap and contralateral free TRAM flap, for 3 patients with pedicle TRAM flap and contralateral deep inferior epigastric perforator (DIEP) flap, for 7 patients with bilateral DIEP flaps, for 1 patient with free muscle-sparing TRAM flap and contralateral DIEP flap. The size of abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly.
Vascular crisis ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdominal incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complication. The patients were followed up with a median period of 12 months (range, 4-42 months). Four patients received reparative operation of their reconstructive breast, and 2 patients received mamopexy of the contralateral breast due to mastoptosis. The abdominal BREAST-Q score was 84.1±11.7, chest score was 86.5±8.9, and breast score was 67.6±16.4 at last follow-up.
The dual-pedicle abdominal flap for unilateral breast reconstruction provides adequate soft tissue volume and good blood supply. It is a reliable and effective breast reconstructive method for patients who need large tissue volume to make symmetric with the contralateral breast, or slim patients with few tissue in the donor site, or patients with scars in the donor site, especially vertical abdominal scars.
探讨双蒂腹壁皮瓣用于单侧乳房重建的有效性。
回顾性分析2014年3月至2018年3月间19例行双蒂腹壁皮瓣重建术的女性患者临床资料，这些患者因单侧乳房切除缺损而接受手术。患者年龄中位数为45岁（范围32 - 51岁），其中即刻乳房重建3例，延期乳房重建16例；左侧7例，右侧12例。8例患者采用单侧带蒂横行腹直肌肌皮瓣（TRAM瓣）联合对侧游离TRAM瓣进行单侧乳房重建，3例采用带蒂TRAM瓣联合对侧腹壁下深动脉穿支（DIEP）瓣，7例采用双侧DIEP瓣，1例采用游离保留肌肉的TRAM瓣联合对侧DIEP瓣。腹壁皮瓣大小为24 cm×7 cm至43 cm×13 cm。供区直接缝合关闭。
1例皮瓣发生血管危象，经手术探查后缓解，其余皮瓣均存活。1例患者腹部切口愈合不良，经清创后成功治愈。其余供区均愈合，无其他并发症。患者中位随访时间为12个月（范围4 - 42个月）。4例患者接受了乳房重建修复手术，2例患者因乳房下垂接受了对侧乳房上提术。末次随访时腹部BREAST - Q评分为84.1±11.7，胸部评分为86.5±8.9，乳房评分为67.6±16.4。
双蒂腹壁皮瓣用于单侧乳房重建可提供足够的软组织量及良好的血供。对于需要大量组织以与对侧乳房对称的患者、供区组织较少的消瘦患者或供区有瘢痕尤其是腹部垂直瘢痕的患者，是一种可靠且有效的乳房重建方法。
