Song D J, Li Z, Zhang Y X, Zhou B, Lyu C L, Tang Y Y, Yi L, Luo Z H, Wang Z Y, Hua Z Z, Feng G
Department of Plastic Surgery, Hunan Cancer Hospital, Changsha 410008, China.
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
Zhonghua Shao Shang Za Zhi. 2021 Dec 20;37(12):1143-1148. doi: 10.3760/cma.j.cn501120-20200824-00390.
To explore the clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator (DIEP) flap in breast reconstruction. A retrospective observational study was used. From December 2008 to December 2016, 24 patients who met the inclusion criteria were treated in the Department of Plastic Surgery of Hunan Cancer Hospital, all patients were female, aged 28-51 (36.5±1.6) years. All cases received turbocharged bipedicle DIEP flap for two-staged breast reconstruction. According to the patterns of turbocharged vessels anastomosis, the turbocharged bipedicle DIEP flaps with length of (27.5±0.3) cm and width of (12.8±1.4) cm, were divided into three types: distal end of pedicle anastomosis type, main branch of pedicle anastomosis type, and muscular branch of pedicle anastomosis type. After complete hemostasis in the donor region, the anterior sheath was repaired with intermittent suture, and umbilical reconstruction was completed. Two negative pressure drainage tubes were indwelled, and subcutaneous tissue and skin were sutured layer by layer. The specific ways of vascular anastomosis of the flap pedicle with the internal thoracic vessels of recipient site included anastomosing the proximal end of one artery and one vein, anastomosing the proximal and distal end of one artery and one vein, and anastomosing the proximal end of one artery and two veins. Postoperatively, the survival and blood supply of flaps were observed. The patients were followed up to observe the reconstructed breast shape satisfaction, donor site complications, abdominal wall function, and scar hyperplasia. All turbocharged bipedicle DIEP flaps for two-staged breast reconstruction survived well, with good blood supply. During follow-up for 14 to 56 (20±6) months, the shape of reconstructed breasts was satisfied. Only linear scar was left in the donor sites of abdomen with no complications, and the function of abdominal wall was not affected. For patients with clear indications, transplantation of free turbocharged bipedicle DIEP flap is a safe, reliable, and satisfactory choice for breast reconstruction with autologous tissue.
探讨带蒂双蒂腹壁下深动脉穿支（DIEP）皮瓣移植在乳房再造中的临床效果。采用回顾性观察研究。2008年12月至2016年12月，湖南省肿瘤医院整形科收治符合纳入标准的患者24例，均为女性，年龄28～51（36.5±1.6）岁。所有病例均采用带蒂双蒂DIEP皮瓣进行二期乳房再造。根据带蒂血管吻合方式，将长度为（27.5±0.3）cm、宽度为（12.8±1.4）cm的带蒂双蒂DIEP皮瓣分为三种类型：蒂端吻合型、蒂主干吻合型、蒂肌支吻合型。供区彻底止血后，间断缝合修复前鞘，完成脐再造。留置两根负压引流管，逐层缝合皮下组织和皮肤。皮瓣蒂部与受区胸廓内血管的血管吻合具体方式包括吻合一根动脉和一根静脉的近端、吻合一根动脉和一根静脉的近端与远端、吻合一根动脉和两根静脉的近端。术后观察皮瓣存活及血供情况。对患者进行随访，观察再造乳房外形满意度、供区并发症、腹壁功能及瘢痕增生情况。所有用于二期乳房再造的带蒂双蒂DIEP皮瓣均存活良好，血供佳。随访14～56（20±6）个月，再造乳房外形满意。腹部供区仅遗留线状瘢痕，无并发症发生，腹壁功能未受影响。对于适应证明确的患者，带蒂双蒂游离DIEP皮瓣移植是自体组织乳房再造安全、可靠且令人满意的选择。
