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早期乳腺癌患者保乳手术中的局部皮瓣:乳腺外科医生的武器库

Local Flaps in Breast-Conserving Surgery in Early Breast Cancer Patients: Armamentarium for Breast Surgeon.

作者信息

Singh Adarsh Pratap, Seenu V, Krishna Asuri, Radhakrishnan Lakshmi

机构信息

Department of Surgical Disciplines, AIIMS, New Delhi, India.

出版信息

Indian J Surg Oncol. 2024 Jun;15(2):258-263. doi: 10.1007/s13193-024-01880-7. Epub 2024 Jan 19.

Abstract

To describe the technique and outcome of local perforator arteries advancement flap in breast-conserving surgeries (BCS) in patient of early breast cancer as our initial experience and review of literature on it. Patients who underwent (BCS) with local perforator artery flap reconstruction were reviewed in terms of their clinical, surgical, and post-operative follow-up details after taking written and informed consent. We have described 4 patients of early breast cancer out of which one patient was post-NACT while 3 were for upfront BCS. We have performed LICAP in 2 patients, AICAP in 1 patient, and IMAP in one patient, depending on the location of primary tumors. None of the patients had any major or minor surgical complications in the post-operative period and drains were removed on post-operative day 2. All patients received post-operative radiotherapy and tolerated well without any loco-regional complications. Patients are in routine follow-up with cosmetic satisfaction without any local recurrence over 1 year. The main advantages of pedicled perforator flaps are well-vascularized tissue, spares underlying muscle leading to lesser donor site morbidity like muscle function and seroma formation, easily reach the breast area with good match in terms of skin and subcutaneous tissue, faster recovery, and shorter learning curve in comparison to free flaps. Knowledge and skill about these flaps will help surgeon to give better surgical outcomes and satisfaction to patients.

摘要

描述早期乳腺癌患者保乳手术(BCS)中局部穿支动脉推进皮瓣的技术及效果,作为我们的初步经验并回顾相关文献。在获得书面知情同意后,对接受局部穿支动脉皮瓣重建的保乳手术患者的临床、手术及术后随访细节进行回顾。我们描述了4例早期乳腺癌患者,其中1例为新辅助化疗后患者,3例为直接进行保乳手术患者。根据原发肿瘤的位置,我们对2例患者进行了侧胸壁穿支皮瓣(LICAP)手术,1例患者进行了腹壁下动脉穿支皮瓣(AICAP)手术,1例患者进行了肋间臂神经穿支皮瓣(IMAP)手术。术后所有患者均未出现任何严重或轻微的手术并发症,术后第2天拔除引流管。所有患者均接受了术后放疗,耐受性良好,未出现任何局部区域并发症。患者在常规随访中对美容效果满意,1年内无局部复发。带蒂穿支皮瓣的主要优点是组织血运良好,保留了深层肌肉,导致供区并发症如肌肉功能和血清肿形成较少,能轻松到达乳房区域,在皮肤和皮下组织方面匹配良好,恢复较快,与游离皮瓣相比学习曲线较短。了解这些皮瓣的知识和技能将有助于外科医生为患者提供更好的手术效果和满意度。

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