Ang Chuan Han, Wong Manzhi
Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore.
J Plast Reconstr Surg. 2022 Mar 2;1(2):58-62. doi: 10.53045/jprs.2021-0006. eCollection 2022 Jul 27.
Breast cancer-related axillary node dissection is the commonest cause of upper extremity lymphedema. The ability of lymphatics to regenerate spontaneously or reconnect with native lymphatics after free or pedicled flap reconstruction has been demonstrated on lymphoscintigraphy. Lymphatic anastomosis is not always needed in these flaps. In patients who underwent axillary clearance with risk factors for the development of lymphedema, we harvested a vascularized serratus anterior fascia flap during concurrent latissimus dorsi flap harvest (for breast or chest wall reconstruction). The vascularized fascia was wrapped around the axillary vessels to provide a conduit for lymphatic regeneration, protect the axillary vessels from radiotherapy, and reduce scarring and axillary cording. This procedure was performed on three patients with none of them experiencing upper limb lymphedema or cording.
乳腺癌相关腋窝淋巴结清扫术是上肢淋巴水肿最常见的原因。淋巴管造影已证实，在游离或带蒂皮瓣重建后，淋巴管有自发再生或与原生淋巴管重新连接的能力。这些皮瓣并不总是需要进行淋巴吻合。对于接受腋窝清扫且有发生淋巴水肿风险因素的患者，我们在同期切取背阔肌皮瓣（用于乳房或胸壁重建）时，切取带血管蒂的前锯肌筋膜瓣。将带血管蒂的筋膜包裹在腋窝血管周围，为淋巴再生提供通道，保护腋窝血管免受放疗影响，并减少瘢痕形成和腋窝条索状挛缩。该手术应用于3例患者，无一例出现上肢淋巴水肿或条索状挛缩。
