Department of Plastic Surgery, St George's University Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
Department of Plastic Surgery, St George's University Hospital, St George's University Hospitals NHS Foundation Trust, London, UK.
BMJ Case Rep. 2022 Jul 20;15(7):e250802. doi: 10.1136/bcr-2022-250802.
Scarring from previous open abdominal surgery in patients undergoing autologous deep inferior epigastric perforator (DIEP) breast reconstruction has been reported to increase overall flap and donor site complication rates. The evidence to date demonstrates that it can be performed safely although with significantly higher postoperative donor site morbidity. It would seem logical that minimal access laparoscopic surgery is less likely to be associated with increased risks to flap vascularity or donor-site complications; however, there is little evidence available in the literature about the impact of previous laparoscopic surgery to the DIEP harvest site. The typical positions for port placement in standard laparoscopic procedures are usually distant from ideal perforator locations reducing the risk of perforator damage. We present a case of unilateral isolated injury to the proximal deep inferior epigastric artery (DIEA) following previous laparoscopic abdominal surgery in a patient undergoing bilateral mastectomy and breast reconstruction with bilateral free DIEP flaps.
先前有报道称，在接受自体腹壁下动脉穿支皮瓣（DIEP）乳房再造的患者中，由于先前的开放性腹部手术导致的瘢痕形成会增加整体皮瓣和供区并发症的发生率。目前的证据表明，尽管术后供区发病率明显更高，但这种手术是可以安全进行的。微创腹腔镜手术似乎不太可能增加皮瓣血供或供区并发症的风险；然而，目前文献中几乎没有关于先前腹腔镜手术对 DIEP 采集部位的影响的证据。标准腹腔镜手术中端口放置的典型位置通常远离理想的穿支位置，从而降低了穿支损伤的风险。我们报告了一例在双侧乳房切除术和双侧游离 DIEP 皮瓣乳房再造的患者中，由于先前的腹腔镜腹部手术，导致近端腹壁下动脉（DIEA）单一损伤的病例。
