Jaiswal Dushyant, Mantri Mayur Raman, Shankhdhar Vinay Kant, Wagh Snehjeet Hemant
Department of Plastic and Reconstructive Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Plast Surg. 2021 Apr;54(2):208-210. doi: 10.1055/s-0041-1730844. Epub 2021 Jun 28.
A 17-year-old girl with large malignant phyllodes tumor of left breast underwent a radical mastectomy with large skin excision resulting in defect of 20 cm × 18 cm. Postoperative radiation therapy necessitated robust cover with flap. The challenge was compounded by her body habitus. Both abdomen and back were deficient as donor sites and a single-island anterolateral thigh (ALT) flap would need skin grafts, volume deficit withstanding. We harvested chimeric ALT plus tensor fascia lata (TFL) perforator free flap sparing all muscles and nerves. Microvascular anastomoses were done to the second internal mammary artery (IMA) perforator artery and vein. The donor site was closed primarily. The TFL flap territory recruited almost three times the volume of ALT territory and allowed us to create a matching breast mound in addition to covering the defect. She tolerated 40 Gy radiation well and doesn't desire further augmentation. Consistency of ALT and TFL perforators makes this a replicable procedure.
一名17岁患有左侧乳腺巨大恶性叶状肿瘤的女孩接受了根治性乳房切除术，切除了大面积皮肤，导致20厘米×18厘米的缺损。术后放疗需要用皮瓣进行充分覆盖。她的体型使这一挑战更加复杂。腹部和背部作为供区都不理想，单岛式股前外侧（ALT）皮瓣即使耐受皮肤移植也会存在体积不足的问题。我们切取了包含阔筋膜张肌（TFL）穿支的嵌合ALT游离皮瓣，保留了所有肌肉和神经。将其与第二肋间内动脉（IMA）穿支动脉和静脉进行了微血管吻合。供区直接缝合。TFL皮瓣区域募集的组织量几乎是ALT区域的三倍，使我们除了覆盖缺损外，还能够塑造出匹配的乳房外形。她顺利耐受了40 Gy的放疗，且不希望进一步隆乳。ALT和TFL穿支的一致性使该手术具有可重复性。
