Chen Ying, Chen Qianjun, Dong Jingjing, Liu Dan, Huang Lezhen, Xie Fengfeng, Zeng Weijie, Li Wenxia, Zhong Shaowen
Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China.
Department of Anesthesia, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China.
Gland Surg. 2021 Sep;10(9):2867-2873. doi: 10.21037/gs-21-176.
Traditionally, breast cancer patients with centrally located mass always receive mastectomy or the combination of central excision and primary closure. With the development of modern oncoplastic breast-conserving techniques, these patients can conserve their breast, and achieve satisfactory cosmetic outcome as well as clear margin. A variety of techniques are available to deal with centrally located breast cancers (CLBCs). Among these techniques, Grisotti flap technique is special, because it is easy to handle, and only causes minor injury by using a local rotational dermoglandular flap to fill the defection of central part. However, in our clinical practice, we find a lot of women in south China have special properties. Such as short distance from inframammary liner to the nipple, long distance from midclavicular to the nipple, and large breast diameter. Simply apply the Grisotti flap technique to those patients is not very suitable that drive us to modify this technique to suit our patients. We adopt the idea that use pedicled skin flap with skin island to replace the central defection to modify Grisotti flap technique. And applied this technique to two patients. We find modified Grisotti flap technique for Paget's disease or CLBC had good cosmetic results as well as safety in suitable patients. In the future, we can use superior pedicle with skin island for ptotic breasts, and lateral pedicle is suitable for patients without large and ptotic breasts.
传统上，患有中央型肿块的乳腺癌患者总是接受乳房切除术或中央切除与一期缝合的联合手术。随着现代肿瘤整形保乳技术的发展，这些患者能够保留乳房，并获得满意的美容效果以及切缘阴性。有多种技术可用于处理中央型乳腺癌（CLBC）。在这些技术中，Grisotti皮瓣技术很特别，因为它操作简便，仅通过使用局部旋转皮瓣来填充中央部分的缺损，造成的损伤较小。然而，在我们的临床实践中，我们发现中国南方的许多女性有特殊的身体特征。例如，从乳房下皱襞到乳头的距离短，从中锁骨到乳头的距离长，以及乳房直径大。简单地将Grisotti皮瓣技术应用于这些患者并不十分合适，这促使我们对该技术进行改良以适合我们的患者。我们采用带皮肤岛状的带蒂皮瓣替代中央缺损的理念来改良Grisotti皮瓣技术。并将该技术应用于两名患者。我们发现改良后的Grisotti皮瓣技术用于佩吉特病或CLBC，在合适的患者中具有良好的美容效果和安全性。未来，对于乳房下垂的患者，我们可以使用带皮肤岛状的上蒂皮瓣，而对于乳房不大且不下垂的患者，侧蒂皮瓣是合适的。
