From the Department of Plastic Surgery, University of Texas Southwestern Medical Center; and the Department of Surgery, Division of Plastic Surgery, Temple University.
Plast Reconstr Surg. 2019 Mar;143(3):488e-494e. doi: 10.1097/PRS.0000000000005375.
Recently, the profunda artery perforator flap has become one of the popular flap choices for patients who desire autologous breast reconstruction but are not optimal candidates for deep inferior epigastric perforator (DIEP) flap surgery. These patients are not ideal patients for DIEP flap surgery because of having poor perforators, previous abdominal operations, low body mass index, or previously used/failed DIEP flap. In their institution, the authors have performed stacked profunda artery perforator flaps for these patients to provide full volumetric and aesthetic reconstruction.
A retrospective review of 20 patients (40 flaps) who underwent stacked profunda artery perforator flap surgery from 2014 to 2018 was performed. Patient characteristics, demographics, and flap data were collected.
Forty flaps were used to reconstruct 20 breasts in 20 patients. The mean age of patients was 51.5 years (range, 38 to 74 years), the average body mass index was 27.3 kg/m(2) (range, 21.0 to 34.4 kg/m(2)), and the mean flap weight was 398.5 g (range, 170 to 600 g). The majority of anastomoses were performed in internal mammary vessels (60 percent), followed by thoracodorsal (10 percent), serratus (10 percent), and side branch of profunda artery perforator vessels (20 percent). There were no flap losses, and two patients experienced donor-site wound dehiscence.
Stacking profunda artery perforator flaps is an innovative yet technically challenging choice of flap for autologous breast reconstruction. It can provide an aesthetically pleasing result in the appropriately selected patient, and we recommend this technique in patients who are not optimal candidates for DIEP flap surgery because of previous flap failure or unavailable donor site.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
最近，深动脉穿支皮瓣已成为渴望自体乳房重建但不适合采用深部下腹壁穿支皮瓣（DIEP）手术的患者的一种流行皮瓣选择。这些患者因穿支较差、既往腹部手术、低体重指数或既往使用/失败的 DIEP 皮瓣而不适合 DIEP 皮瓣手术。在他们的机构中，作者为这些患者进行了堆叠深动脉穿支皮瓣手术，以提供全面的体积和美学重建。
对 2014 年至 2018 年间接受堆叠深动脉穿支皮瓣手术的 20 名患者（40 个皮瓣）进行了回顾性研究。收集患者特征、人口统计学和皮瓣数据。
20 名患者的 40 个皮瓣用于重建 20 个乳房。患者的平均年龄为 51.5 岁（范围为 38 至 74 岁），平均体重指数为 27.3kg/m²（范围为 21.0 至 34.4kg/m²），平均皮瓣重量为 398.5g（范围为 170 至 600g）。大多数吻合部位在内乳血管（60%），其次是胸背血管（10%）、胸侧肌（10%）和深动脉穿支血管的侧支（20%）。没有皮瓣丢失，有 2 名患者出现供区伤口裂开。
堆叠深动脉穿支皮瓣是一种具有创新性但技术上具有挑战性的自体乳房重建选择。它可以为适当选择的患者提供美观的效果，我们建议在因先前皮瓣失败或供区不可用而不适合 DIEP 皮瓣手术的患者中使用这种技术。
临床问题/证据水平：治疗性，IV。
