From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center; and the Division of Plastic and Reconstructive Surgery, University of Iowa Hospitals and Clinics.
Plast Reconstr Surg. 2021 May 1;147(5):1059-1061. doi: 10.1097/PRS.0000000000007889.
One key component of a successful autologous breast reconstruction is insetting the flap to accurately resemble an aesthetic breast. The authors describe a novel technique used to shape a deep inferior epigastric artery perforator flap into a coned breast mound before introducing it into the breast pocket. With the flap perfusing on the chest wall, an area of skin estimating the size and location of the skin paddle is marked. The skin to be buried is then deepithelialized. Once hemostasis is ensured, the shaping is performed. Two 2-0 polydioxanone sutures are anchored in the Scarpa fascia at the 10- and 2-o'clock positions and then run at the level of the Scarpa fascia to the 6-o'clock position. The two sutures are then cinched together to achieve the desired shape and then tied. The flap is then placed in the breast pocket and secured into place at the inferomedial and inferolateral corners, and at its cranial aspect. The size of the skin paddle can then be finalized. In the authors' series of 21 breast reconstructions in 11 patients using flap preshaping, they have not seen any compromise in flap perfusion, with one patient showing a small area of secondary fat necrosis. In addition, the flaps maintained their aesthetic breast shape throughout follow-up. The authors believe this technique for shaping inferior epigastric artery perforator flaps before inset into the breast pocket to be both safe and predictable, simplifying one of the more tedious aspects of autologous breast reconstruction.
成功的自体乳房重建的一个关键因素是将皮瓣准确地嵌入以形成美观的乳房。作者描述了一种在将深部腹壁下动脉穿支皮瓣引入乳房袋之前将其塑造成圆锥形乳房丘的新技术。在皮瓣在胸壁上灌注时，标记出估计皮瓣大小和位置的皮肤区域。然后对要埋藏的皮肤进行去表皮化处理。一旦止血得到保证，就进行塑形。将两根 2-0 聚二氧杂环已酮缝线固定在 Scarpa 筋膜的 10 点和 2 点位置，然后沿着 Scarpa 筋膜的水平运行至 6 点位置。然后将两根缝线拉紧以达到所需的形状并系紧。然后将皮瓣放入乳房袋中，并在内下和内下侧角以及颅侧固定。然后可以确定皮瓣的大小。在作者的 11 名患者的 21 例乳房重建中使用皮瓣预成形术，他们没有看到任何皮瓣灌注的并发症，只有 1 名患者出现了小块继发性脂肪坏死。此外，在随访期间，皮瓣保持了其美观的乳房形状。作者认为，在将腹壁下动脉穿支皮瓣嵌入乳房袋之前对其进行塑形的技术既安全又可预测，简化了自体乳房重建中较为繁琐的一个方面。
