Song D J, Li Z, Zhou Y X, Zhang P, Zhou C L, Lyu Y Y, Tang L, Yi Z H, Luo Zhenhua
Department of Oncology 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 Yu Chuang Mian Xiu Fu Za Zhi. 2022 Oct 20;38(10):964-967. doi: 10.3760/cma.j.cn501225-20220306-00047.
On May 14, 2020, a 37 year old female patient with unilateral breast cancer was admitted to Hunan Cancer Hospital. She underwent modified radical mastectomy for right breast cancer and free transplantation of bilateral superficial inferior epigastric artery perforator flap (weighed 305 g) for breast reconstruction. During the operation, the right inferior epigastric vascular pedicle was anastomosed with the proximal end of the right internal mammary vessel, and the left inferior epigastric vascular pedicle was anastomosed with the distal end of the right internal mammary vessel; the blood flow of the flap was good; the wound in the donor site of the abdominal flap was closed directly. The operation lasted for 9 hours. In the first 48 hours post operation, the flap showed mild elevation in perfusion over drainage, but no obvious edema or blister was observed, flap temperature was consistent with the surrounding skin, and the drainage volume out of drainage tube was only 40 mL. The blood supply of the flap was completely restored to normal 3 days post operation, the flap survived well, the donor site incision had no obvious tension, and the healing was smooth. After 2 months of follow-up, the donor site incision of abdomen healed completely, only linear scar was left, and the reconstructed breast had a natural appearance; the patient planned to perform further nipple reconstruction and contralateral breast mastopexy. This case suggests that autologous breast reconstruction can be performed using bilateral superficial inferior epigastric artery perforator flaps under certain circumstances to minimize donor site injury to the greatest extent.
2020年5月14日,一名37岁的单侧乳腺癌女性患者入住湖南省肿瘤医院。她接受了右乳癌改良根治术,并采用双侧腹壁浅动脉穿支皮瓣游离移植(皮瓣重305g)进行乳房重建。手术过程中,将右侧腹壁下血管蒂与右侧胸廓内血管近端吻合,左侧腹壁下血管蒂与右侧胸廓内血管远端吻合;皮瓣血运良好;腹部皮瓣供区伤口直接缝合。手术持续了9小时。术后48小时内,皮瓣灌注略高于引流量,但未观察到明显水肿或水疱,皮瓣温度与周围皮肤一致,引流管引流量仅40mL。术后3天皮瓣血供完全恢复正常,皮瓣存活良好,供区切口无明显张力,愈合顺利。随访2个月后,腹部供区切口完全愈合,仅留线性瘢痕,再造乳房外形自然;患者计划进一步行乳头再造及对侧乳房上提术。该病例提示,在某些情况下,可采用双侧腹壁浅动脉穿支皮瓣进行自体乳房重建,以最大程度减少供区损伤。