UOC Chirurgia Plastica, Dipartimento Scienze Salute della Donna, del Bambino e di Sanità Pubblica, Università Cattolica del "Sacro Cuore," Milan, Italy.
Fondazione Policlinico Universitario "Agostino Gemelli" IRCSS, Rome, Italy.
J Reconstr Microsurg. 2022 Mar;38(3):228-232. doi: 10.1055/s-0041-1740127. Epub 2021 Dec 6.
Lateral thoracic flaps represent a precious source for partial and total breast reconstruction, in some cases as first option and in other cases as alternative of free flaps. This article describes the ultrasound (US)-based planning of the lateral thoracic wall perforator adipocutaneous flaps and it reports our experience on 52 consecutive flaps.
From November 2018 to May 2021, 52 consecutive lateral thoracic wall perforator flaps were performed using the US-based method for reconstruction of partial breast defects and total breast reconstruction. High-frequency US was performed in all cases prior to surgery to select the best perforator and design the flap.
Of the 52 cases, 41 were lateral intercostal artery perforator flaps (78.8%), and 11 were thoracodorsal artery perforator (TDAP) flaps. Of the 11 TDAP flaps, 2 cases were based on the direct cutaneous branch. Moreover, in two other cases clinically scheduled for lateral thoracic perforator flaps due to the presence of an appropriate axillary roll, no suitable local/regional perforators were detected with the preoperative US examination and the latissimus dorsi myocutaneous flap was performed.
Preoperative planning of these flaps using US speeds the surgery and makes it easier and more efficient. Therefore, it is reasonable that the color duplex ultrasound is the operative surgeon's tool for mapping the lateral thoracic wall perforators and to appropriately plan each flap.
外侧胸壁皮瓣是部分和全乳重建的宝贵来源，在某些情况下作为首选，在其他情况下作为游离皮瓣的替代。本文描述了外侧胸壁穿支皮瓣的超声（US）规划，并报告了我们在 52 例连续皮瓣中的经验。
从 2018 年 11 月至 2021 年 5 月，我们使用基于 US 的方法对 52 例连续外侧胸壁穿支皮瓣进行了部分乳房缺损和全乳房重建。所有病例均在术前进行高频 US，以选择最佳穿支并设计皮瓣。
52 例中，41 例为外侧肋间动脉穿支皮瓣（78.8%），11 例为胸背动脉穿支（TDAP）皮瓣。11 例 TDAP 皮瓣中，2 例基于直接皮支。此外，在另外两例因腋部卷适合行外侧胸壁穿支皮瓣的病例中，术前 US 检查未发现合适的局部/区域穿支，而行背阔肌肌皮瓣。
使用 US 对这些皮瓣进行术前规划可加快手术速度，使手术更简单、更高效。因此，彩色双功能超声是手术医生用于绘制外侧胸壁穿支并适当规划每个皮瓣的工具是合理的。
