游离腹壁下深动脉穿支皮瓣一期重建乳房

Deep inferior epigastric perforator (DIEP) free flap in immediate breast reconstruction

目的 行乳癌改良根治术同时应用游离腹壁下深动脉穿支 (deepinferiorepigastricper forator,DIEP)皮瓣行一期乳房再造 ,以降低术后并发症的发生率。方法 2 0 0 1年 12月～ 2 0 0 3年 1月对 12例患单侧乳癌的女性患者 ,在行乳癌改良根治术的同时用游离DIEP皮瓣行一期乳房再造 ,受区血管采用胸背动、静脉或胸廓内动、静脉。结果 本组 12例DIEP皮瓣中有 1例因为下腹部多条瘢痕 ,术后整块皮瓣坏死 ,其余 11例全部存活。 11例再造乳房和对侧乳房大小基本一致 ,术后无一例发生腹壁薄弱、腹部包块、腹壁疝等。结论 DIEP皮瓣是利用自体组织一期重建乳房合理可靠的新方法 ,较TRAM皮瓣 ,术后供区的并发症明显降低 ,康复快 ,但手术较复杂、时间较长 ,对外科技术的要求较高。

Objective In order to facilitate psychological rehabilitation of the women who underwent modified radical mastectomy for breast cancer, the DIEP free flap was used for immediate breast reconstruction in a series of patients. We present a review of the surgical outcomes. Methods From December 2001 to January 2003, unilateral breast reconstruction was performed in 12 patients using the DIEP free flap at the same time of modified radical mastectomy in our department. The recipient vessels were the thoracodorsal artery and vein or the internal mammary artery and its venae concomitants. Results Of the 12 DIEP flaps, 1 was vascularized by a single perforator, 3 were vascularized by two perforators, 6 by three perforators, 1 by four an 1 by five perforators. One flap failed totally, likely due to previous multiple lower abdominal operations. The eleven reconstructed breasts achieved almost the same size and shape as the healthy sides. The time of patient getting out of bed ranged from 3 to 7 days and the mean hospital stay was 8.8 days. All patients were satisfied with the outcome. No complications were observed in the abdominal wall, including weakness, abdominal bulge or hernia. Conclusion Immediate breast reconstruction facilitates the psychological rehabilitation and helps to avoid the dressing inconveniences resulted from total mastectomy. Free DIEP flap is a new and reliable technique for immediate breast reconstruction with autologous tissue. This flap offers the patients the same advantages as the TRAM flap and avoids its most important disadvantage of potential abdominal wall weakness, by preserving the continuity of the rectus abdominis muscle. The donor site morbidity is thus reduced and recovery is faster. The more complex nature of this procedure leads to increased operating time and requires more demanding surgical skills.