Tamura Shihoko, Satake Toshihiko, Muto Mayu, Shibuya Mai, Narui Kazutaka, Kobayashi Shinji, Ishikawa Takashi, Maegawa Jiro
Department of Plastic and Reconstructive Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
Plast Reconstr Surg Glob Open. 2019 Dec 26;7(12):e2552. doi: 10.1097/GOX.0000000000002552. eCollection 2019 Dec.
Mastectomy and flap harvesting can be accomplished simultaneously in immediate deep inferior epigastric perforator (DIEP) flap breast reconstruction. However, this is not always possible, particularly in a teaching institution, where supervisors, trainees, and assistants must participate in the surgery, because there is not enough working space for breast and plastic surgeons to perform surgery together. We attempted to overcome this problem by placing the patient in the lithotomy position and have reported the outcomes. We evaluated patients who underwent unilateral immediate DIEP flap breast reconstruction in the supine or lithotomy position between October 2014 and July 2016. The surgeries were performed by the same inexperienced plastic surgeon in our hospital. In the lithotomy position, 1 plastic surgeon stands between the patient's legs and 1 stands beside the abdomen, and they perform DIEP flap harvesting simultaneously with mastectomy performed by 3 breast surgeons. After mastectomy, breast reconstruction is performed by 4 plastic surgeons. The supine position was used in the first 8 patients, and the lithotomy position was used in the following 8 patients. The mean operative time was 11 hours 21 minutes in the supine group and 8 hours 52 minutes in the lithotomy group, with a significant difference ( = 0.027). Breast reconstruction with a DIEP flap in the lithotomy position is useful for teaching institutions because it provides sufficient working space and allows simultaneous procedures without prolonging operative time. However, issues such as pressure sores, nerve palsy, and difficulty in patient placement still exist.
在即刻乳房重建中，乳房切除术和皮瓣切取可同时进行，采用腹壁下深动脉穿支（DIEP）皮瓣乳房重建术。然而，这并非总是可行，尤其是在教学机构中，由于没有足够的操作空间让乳腺外科医生和整形外科医生同时进行手术，所以带教老师、实习生和助手都必须参与手术。我们试图通过将患者置于截石位来克服这一问题，并已报告了相关结果。我们评估了2014年10月至2016年7月间接受单侧即刻DIEP皮瓣乳房重建术的患者，手术均由我院同一位经验不足的整形外科医生进行。在截石位时，1名整形外科医生站在患者双腿之间，1名站在腹部旁边，他们与3名乳腺外科医生同时进行乳房切除术并切取DIEP皮瓣。乳房切除术后，由4名整形外科医生进行乳房重建。前8例患者采用仰卧位，后8例采用截石位。仰卧位组的平均手术时间为11小时21分钟，截石位组为8小时52分钟，差异有统计学意义（P = 0.027）。在截石位进行DIEP皮瓣乳房重建术对教学机构很有用，因为它提供了足够的操作空间，并能同时进行手术而不延长手术时间。然而，诸如压疮、神经麻痹和患者体位摆放困难等问题仍然存在。
