组织工程与重建外科杂志

组织工程与重建外科杂志 ›› 2024, Vol. 20 ›› Issue (4): 428-.

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分叶游离下腹部皮瓣移植乳房再造的血管吻合方式选择

  

  • 出版日期:2024-08-01 发布日期:2024-09-11

Selection of vascular anastomosis methods for breast reconstruction using lobed free lower abdominal flap transplantation

  • Online:2024-08-01 Published:2024-09-11

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摘要：

目的　总结分叶游离下腹部皮瓣移植再造乳房的适应证和血管吻合方式选择。方法　自2019年10月至2023年6月，在17例女性乳腺癌患者中完成分叶游离下腹部皮瓣移植乳房再造，包括10例即刻乳房再造和7例延期乳房再 造。全部采用分叶游离下腹部皮瓣移植完成，包括M1型游离腹直肌皮瓣20侧，M2型6侧，M3型8侧。血管吻合方式具 体包括：外增压方式9例，内增压方式8例。受区血管包括胸廓内血管近心端14侧，胸背血管主干10侧，前锯肌支3侧， 胸外侧动静脉2例，胸廓内血管远心端5侧。结果　每侧皮瓣长（14.2±0.4） cm、宽（11.5±1.0） cm、厚（4.9±0.3） cm。所有 皮瓣血运良好，全部顺利成活。术后随访6~38个月，平均20.7个月，乳腺癌未见复发，再造乳房外形可，质地满意，无皮 瓣挛缩变形，与健侧乳房外形基本对称；皮瓣供区及乳房受区仅遗留线性瘢痕，腹壁功能无明显影响。结论　分叶游离 下腹部皮瓣适用于底盘及垂度凸度都较大的乳房再造，选择合理的血管吻合方式可以确保皮瓣的自由摆放和满意的乳 房塑形。

关键词: 分叶皮瓣, 　游离腹直肌皮瓣, 　乳房再造, 　乳腺癌

Abstract: Objective　To summarize the indications and vascular anastomosis methods selection for the transplantation of lobed free lower abdominal flap for breast reconstruction. Methods　 From October 2019 to June 2023， 17 female breast cancer patients received lobulated free lower abdominal flap transfer for breast reconstruction， including 10 cases of immediate breast reconstruction and 7 cases of delayed breast reconstruction. All the cases were completed by transplantation of lobulated free lower abdominal flaps， including 20 M1 type free rectus abdominis skin flaps， 6 M2 types， and 8 M3 types. The specific vascular anastomosis methods include supercharge in 9 cases and turbocharge in 8 cases. The recipient vessels include 14 sides of the proximal end of the internal mammary vessels， 10 sides of the main trunk of the thoracodorsal vessels， 3 sides of the serratus anterior branches， 2 cases of the lateral thoracic artery and vein， and 5 sides of the distal end of the internal mammary vessels. Results　 Each side flap had a length of （14.2±0.4） cm， a width of （11.5±1.0） cm， and a thickness of（ 4.9±0.3） cm. All flaps had good blood circulation and all survived smoothly. All patients were followed up for 6 to 38 months （20.7 months on average）， no recurrence was noted. The reconstructed breasts had good appearance， satisfactory texture， no flap contracture and deformation， and was basically symmetrical with the healthy breast. The flap donor site and breast recipient area only had linear scars left， and there was no significant impact on abdominal wall function.Conclusion　The lobed free lower abdominal flap is suitable for breast reconstruction with large base and sagging convexity. Choosing a reasonable vascular anastomosis method can ensure the free placement of the flap and satisfactory breast shaping.

Key words:

Conclusion　The lobed free lower abdominal flap is suitable for breast reconstruction with large base and sagging convexity. Choosing a reasonable vascular anastomosis method can ensure the free placement of the flap and satisfactory breast shaping.