Al-Malat Tarek, Taskin Berivan, Schäller Sebastian, Mettal-Minski Daniela, Mannil Lijo
Department of Plastic and Aesthetic Surgery, St. Vinzenz Hospital, Cologne, Germany.
Department of Rheumatology, Helios Klinik Attendorn, Germany.
GMS Interdiscip Plast Reconstr Surg DGPW. 2023 Mar 2;12:Doc01. doi: 10.3205/iprs000171. eCollection 2023.
The deep inferior epigastric artery perforator (DIEP) flap is an excellent option for microsurgical breast reconstruction. In selected cases, e.g. in case of previous abdominoplasty, other autologous options like transverse upper gracilis (TUG) or superior gluteal artery perforator (sGAP) flaps can be considered. The anterolateral thigh (ALT) flap is reported to be used as a salvage procedure in selected cases of breast reconstruction, where other flaps were not available or failed. We present a case of a 41-year-old woman who was undergoing bilateral breast reconstruction after bilateral mastectomies following implant-based mastopexie and multiple infections. She also suffered from an adult onset Still's disease (AOSD) and was thus immunosuppressed. Microsurgical breast reconstruction was performed in a two-stage procedure. The left breast was reconstructed using a TUG flap. On the right side the TUG reconstruction failed due to vascular anomaly, so an ALT flap was successfully used instead. The whole procedure was accompanied by a multidisciplinary approach including a rheumatological complex treatment and enabled a successful bilateral breast reconstruction in this challenging case.
腹壁下动脉穿支（DIEP）皮瓣是显微外科乳房重建的理想选择。在某些特定情况下，例如既往有腹部整形手术史，可考虑其他自体皮瓣，如股薄肌肌皮瓣（TUG）或臀上动脉穿支（sGAP）皮瓣。据报道，在其他皮瓣不可用或失败的特定乳房重建病例中，股前外侧（ALT）皮瓣可作为补救手术使用。我们报告一例41岁女性，在基于植入物的乳房上提术及多次感染后行双侧乳房切除术后接受双侧乳房重建。她还患有成人斯蒂尔病（AOSD），因此处于免疫抑制状态。显微外科乳房重建分两期进行。左侧乳房采用TUG皮瓣重建。右侧由于血管异常，TUG重建失败，因此成功改用ALT皮瓣。整个过程采用多学科方法，包括风湿免疫综合治疗，在这一具有挑战性的病例中实现了成功的双侧乳房重建。
