应用腹壁下动脉穿支皮瓣再造乳房

CLINICAL EXPERIENCES OF BREAST RECONSTRUCTION USING DEEP INFERIOR EPIGASTRIC PERFORATOR FLAPS

目的对应用腹壁下动脉穿支(deepinferiorepigastricperforator,DIEP)皮瓣进行乳房再造进结。方法2000年3月~2005年3月,收治18例患者,其中因乳腺癌导致乳房缺损17例,术前行放射治疗者7例放射治疗者10例;先天性Poland’s综合征1例。胸壁缺损范围12cm×8cm^25cm×20cm。应用DIEP皮瓣游离进行乳房再造,皮瓣切取范围12cm×8cm^35cm×22cm。15例乳房再造患者使用的受区血管是胸廓内血管,其中腹壁下动、静脉分别与切断后的胸廓内动、静脉近、远心端行吻合者13例;仅切取一侧腹壁下血管,与胸廓内动、静心端行吻合者2例。3例行即刻乳房再造者使用的受区血管分别是胸背动、静脉和胸背动、静脉加旋肩胛动、静脉。18例患者中16例术后皮瓣全部成活,2例术后出现皮瓣坏死。其中行放射治疗1例,未行放射治疗1例。Poland合征患者术后皮瓣远端约1/3面积坏死。术后半年行乳头再造和乳房修整者2例。2例术后2周出现腹部供瓣区正口部分裂开,行创面清创后,分别应用直接缝合和植皮的方法进行修复。结论DIEP皮瓣在保留了传统下腹部横直肌皮瓣乳房再造所具有的优点同时,可最大限度保留腹直肌的功能,从而避免术后出现腹壁薄弱、腹壁疝等并发目前较理想的乳房再造方式。

Objective To summarize the experiences of the breast reconstruction using the deep inferior epigastric perforator （DIEP） flaps. Methods From March 2000 to March 2005, 18 cases of breast defects were treated. Defect was caused by mammary cancer in 17 cases and by Poland＇s syndrome in 1 case. Preoperative radiotherapy was given in 7 patients. The size of the chest wall defects ranged from 25 cm×20 cm to 12 cm×8 cm. All the breasts were reconstructed with the DIEP flaps. The flap size ranged from 35 cm×22 cm to 12 cm×8 cm （mean 9.58 cm×26.85 cm）. The internal mammary vessels were used as the recipient vessels in 15 patients who underwent delayed breast reconstruction. Among these cases, the bilateral deep inferior epigastric vessels were anastomosed with the proximal and distal ends of the internal mammary vessels separately in 13 cases and only unilateral deep inferior epigastric vessels were harvested and anastomosed to the proximal ends of the internal mammary vessels in 2 cases. The recipient vessels were the thoracodorsal vessels and thoracodorsal vessels plus the circumflex scapular vessels in the patients who underwent immediate breast reconstruction. Results Sixteen flaps survived completely postoperatively and the survival rate was 89%. Flap necrosis occurred in 2 patients; one underwent radiotherapy preoperatively while the other did not. The distal 1/3 portion of the flap neerosed in the patient with Poland＇s syndrome. Nipple reconstruction and breast remolding were performed in 2 patients. Partial dehiscence of the median abdominal incision occurred in 2 patients at 2 weeks postoperatively and were repaired with resuturing and split-thickness skin grafting separately. Conclusion Breast reconstruction using the DIEP flaps not only can preserve the advantages of the traditional method using the transverse rectus ablominis myocutaneous flaps, but also can retain the maximal function of the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia. It is an ideal method of the breast reconstruction.