Thomsen Jørn Bo, Rindom Mikkel Børsen, Rancati Alberto, Angrigiani Claudio
Research Unit for Plastic Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.
Arch Plast Surg. 2021 Jan;48(1):15-25. doi: 10.5999/aps.2020.01410. Epub 2021 Jan 15.
Thoracodorsal artery (TDA) flaps, ranging from the vascular-pedicled thoracodorsal artery perforator (TDAP) flap, the propeller TDAP flap, and the muscle-sparing latissimus dorsi (MSLD) flap to the conventional latissimus dorsi (LD) flap and the extended LD flap, can all be used for breast reconstruction. The aim of this paper and review is to share our experiences and recommendations for procedure selection when applying TDA-based flaps for breast reconstruction. We describe the different surgical techniques and our thoughts and experience regarding indications and selection between these procedures for individual patients who opt for breast reconstruction. We have performed 574 TDA flaps in 491 patients: 60 extended LD flaps, 122 conventional LD flaps, two MSLD flaps, 233 propeller TDAP flaps, 122 TDAP flaps, and 35 free contralateral TDAP flaps for stacked TDAP breast reconstruction. All the TDA flaps are important flaps for reconstruction of the breast. The LD flap is still an option, although we prefer flaps without muscle when possible. The vascular-pedicled TDAP flap is an option for experienced surgeons, and the propeller TDAP flap can be used in most reconstructive cases of the breast, although a secondary procedure is often necessary for correction of the pedicle bulk. The extended LD flap is an option for women with a substantial body mass index, although it is associated with the highest morbidity of all the TDA flaps. The MSLD flap can be used if the perforators are small or if dissection of the perforators is assessed to be hazardous.
胸背动脉（TDA）皮瓣，从带血管蒂的胸背动脉穿支（TDAP）皮瓣、推进式TDAP皮瓣、保留肌肉的背阔肌（MSLD）皮瓣到传统的背阔肌（LD）皮瓣和扩展背阔肌皮瓣，均可用于乳房重建。本文及综述的目的是分享我们在应用基于TDA的皮瓣进行乳房重建时的手术经验及手术选择建议。我们描述了不同的手术技术，以及对于选择乳房重建的个体患者在这些手术的适应症和选择方面的想法和经验。我们已对491例患者实施了574例TDA皮瓣手术：60例扩展背阔肌皮瓣、122例传统背阔肌皮瓣、2例保留肌肉的背阔肌皮瓣、233例推进式TDAP皮瓣、122例TDAP皮瓣以及35例用于叠加TDAP乳房重建的对侧游离TDAP皮瓣。所有TDA皮瓣都是乳房重建的重要皮瓣。背阔肌皮瓣仍是一种选择，不过我们尽可能更倾向于使用不带肌肉的皮瓣。带血管蒂的TDAP皮瓣适合经验丰富的外科医生，推进式TDAP皮瓣可用于大多数乳房重建病例，尽管通常需要二次手术来矫正蒂部臃肿问题。扩展背阔肌皮瓣适合身体质量指数较高的女性，尽管它是所有TDA皮瓣中发病率最高的。如果穿支较小或评估穿支解剖有风险，可使用保留肌肉的背阔肌皮瓣。
