Martinez Carlos A, Fairchild Berry, Secchi-Del Rio Roberto, Boutros Sean G
My Houston Surgeons, Houston, Tex.
The University of Texas Health Science Center at Houston, Houston, Tex.
Plast Reconstr Surg Glob Open. 2021 Oct 18;9(10):e3878. doi: 10.1097/GOX.0000000000003878. eCollection 2021 Oct.
Stacking free flaps for breast reconstruction is far from novel, even in the case of a deep inferior epigastric perforator (DIEP) plus profunda artery perforator (PAP) configuration, where the latter is always described in the traditional transverse configuration. We present a series of consecutive patients undergoing bilateral breast reconstruction with stacked DIEP and vertical PAP flaps.
Patients with inadequate abdominal donor tissue were offered the possibility of a stacking breast reconstruction. The DIEP flap was harvested via microfascial incisions, whereas the vertical PAP flap was harvested in the lithotomy position, following the course of the gracilis muscle.
In total, 28 consecutive patients with a mean BMI of 24.9 underwent bilateral breast reconstruction with stacked DIEP and vertical PAP flaps. The internal mammary artery and vein were used as recipient vessels in all 56 stacked flaps. Fifty-three PAP flaps were anastomosed to the distal portion of the (primary) DIEP flaps utilizing a sequential flap anastomosis technique, and one DIEP flap was anastomosed to the distal portion of the (primary) PAP flap. Hospitalization for the initial eight patients averaged 35 hours, whereas the following 20 patients were discharged within 23 hours. There were no postoperative takebacks or vascular complications.
Stacked DIEP/PAP flaps offer an excellent option for patients who require more volume than available from DIEP flaps alone. When compared with transverse PAP flaps, the vertical PAP offers excellent variability of volume and ease of shaping to allow for excellent results, while minimizing donor site tension in the seated position and preserving the gluteal fold.
即使是在下腹部深动脉穿支（DIEP）加旋股深动脉穿支（PAP）皮瓣的情况下，堆叠游离皮瓣用于乳房重建也并非新鲜事，后者通常采用传统的横向构型。我们报告了一系列连续接受双侧乳房重建的患者，采用堆叠的DIEP皮瓣和垂直PAP皮瓣。
对于腹部供区组织不足的患者，提供了堆叠式乳房重建的可能性。DIEP皮瓣通过显微筋膜切口切取，而垂直PAP皮瓣则在截石位沿股薄肌走行切取。
共有28例连续患者，平均BMI为24.9，接受了堆叠DIEP皮瓣和垂直PAP皮瓣的双侧乳房重建。所有56个堆叠皮瓣均以内乳动脉和静脉作为受区血管。53个PAP皮瓣采用序贯皮瓣吻合技术与（主要的）DIEP皮瓣的远端吻合，1个DIEP皮瓣与（主要的）PAP皮瓣的远端吻合。最初8例患者的住院时间平均为35小时，而随后的20例患者在23小时内出院。术后无回纳或血管并发症。
对于那些需要的组织量超过单纯DIEP皮瓣所能提供的患者，堆叠DIEP/PAP皮瓣是一个极佳的选择。与横向PAP皮瓣相比，垂直PAP皮瓣在组织量变化方面表现出色，易于塑形，可取得优异效果，同时能最大程度减少坐位时供区的张力，并保留臀沟。
