Gorji Shaghayegh, Varnava Charalampos, Aitzetmüller Matthias, Klietz Marie-Luise, Hirsch Tobias, Wiebringhaus Philipp
Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie , Fachklinik Hornheide eV, Münster, Germany.
Sektion Plastische und Rekonstruktive Chirurgie an der Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Germany.
Handchir Mikrochir Plast Chir. 2023 Aug;55(4):262-267. doi: 10.1055/a-2084-0893. Epub 2023 Jun 22.
In recent years, the PAP (profunda artery perforator) flap has gained popularity in reconstructive breast surgery. However, the tissue available for flap harvest is usually limited. Therefore, grafting two PAP flaps to form a stacked PAP flap for unilateral reconstruction of large breasts is a safe and reliable option. Patient We present the case of a 59-year-old patient arriving at our unit with prior bilateral nipple-sparing mastectomy and implant-based reconstruction after diagnosis of BRCA-2 mutation and breast cancer. Autologous reconstruction with a DIEP flap was the initial treatment suggested to our patient. Preoperative CT scans showed subpar perforators not suitable for anastomosis, ultimately resulting in unilateral DIEP flap reconstruction on the left side. After an uneventful postoperative period, the patient requested autologous conversion of the right side due to persistent symptomatic capsular contracture. To achieve symmetry with the contralateral breast, we decided to perform a stacked PAP flap for unilateral breast reconstruction.
The combined flaps provided enough tissue to achieve a satisfactory aesthetic result and symmetry and weighed 600 g in total, while the single DIEP flap on the left side weighed 716 g. There were no complications during the surgical procedure. Postoperative recovery was uneventful, and the patient was discharged after seven days. There were no signs of adipose tissue necrosis at the most recent check-up. On the left donor side, there was a small wound healing defect, which healed well non-surgically. The patient was satisfied with the results.
The PAP flap has become an established alternative to standard breast reconstruction procedures. The stacked PAP flap can provide a safe and efficient method for unilateral reconstruction of large breasts. Perfusion and drainage through the inferiorly anastomosed flap showed sufficient outflow and did not lead to increased adipose tissue necrosis. In our case, the total surgery time was not substantially longer than in single PAP flap surgery. Furthermore, the possibility of unilateral placement of two flaps may avoid follow-up operations such as multiple lipotransfers to equalise both breasts.
近年来，股深动脉穿支（PAP）皮瓣在乳房重建手术中越来越受欢迎。然而，可用于切取皮瓣的组织通常有限。因此，移植两个PAP皮瓣以形成堆叠式PAP皮瓣用于单侧大乳房重建是一种安全可靠的选择。
我们介绍了一名59岁患者的病例，该患者在诊断出BRCA-2基因突变和乳腺癌后，先前接受了双侧保留乳头的乳房切除术并进行了植入物重建。最初建议我们的患者采用腹壁下动脉穿支（DIEP）皮瓣进行自体重建。术前CT扫描显示穿支血管不理想，不适合吻合，最终导致左侧进行了单侧DIEP皮瓣重建。术后恢复顺利，由于持续性症状性包膜挛缩，患者要求对右侧进行自体转换。为了与对侧乳房对称，我们决定进行堆叠式PAP皮瓣单侧乳房重建。
联合皮瓣提供了足够的组织，以获得令人满意的美学效果和对称性，总重量为600克，而左侧的单个DIEP皮瓣重量为716克。手术过程中没有并发症。术后恢复顺利，患者在七天后出院。在最近的检查中没有脂肪组织坏死的迹象。在左侧供区，有一个小的伤口愈合缺陷，通过非手术方法愈合良好。患者对结果感到满意。
PAP皮瓣已成为标准乳房重建手术的既定替代方案。堆叠式PAP皮瓣可为单侧大乳房重建提供一种安全有效的方法。通过低位吻合皮瓣的灌注和引流显示出足够的流出量，并且不会导致脂肪组织坏死增加。在我们的病例中，总手术时间并不比单PAP皮瓣手术长得多。此外，单侧放置两个皮瓣的可能性可以避免后续手术，如多次脂肪移植以平衡双侧乳房。
