腹壁下动脉穿支(DIEP)皮瓣自体组织移植乳房再造

Breast Reconstruction by Using Transverse Rectus Abdominis Flap with Deep Inferior Epigastric Perforator (DIEP)

目的为乳腺癌切除术后,乳房缺失的病人建立一种供区隐蔽、损伤小,形态逼真,多数病人愿意接受的自体组织移植乳房再造的方法。方法在以腹直肌为蒂的横型腹直肌肌皮瓣TRAM的基础上,保留腹直肌及其前鞘,形成以腹壁下动脉及其肌肉穿支直接供血的横行下腹部游离皮瓣进行乳房再造。受区血管选择同侧或对侧胸廓内动、静脉。根据再造乳房的水平高度,血管吻合点定位在不同肋间。皮瓣移植后供区直接缝合。结果本组用腹壁下动脉穿支(deep inferior epigastric perforator,DIEP)皮瓣游离移植乳房再造,共46例,41例双蒂穿支皮瓣的病例全部成活;5例单侧穿支供血的皮瓣其中2例远端出现缺血现象。随访5个月-3年,再造乳房外形、质地满意,未见腹壁薄弱、腹疝等腹部并发症发生。下腹供区瘢痕隐蔽,同时也达到了腹壁整形减肥的效果。结论横行下腹部DIEP瓣乳房再造,供区损伤小、组织量充足、血供丰富,是目前最为理想的手术方法。DIEP瓣也能根据需要修复多种软组织缺损,本方法在满足受区需要的同时最大限度地避免或减少供区的损伤。这种皮瓣的应用代表了整形外科皮瓣移植的发展方向。

Objectives To provide a kind of autogenous breast reconstruction technique for patients who suffered from breast loss after mastectomy. The donor site was hidden and has decreased morbidity. Method On the basis of pedicle transverse rectus abdominis musculocutaneous (TRAM) flap, the rectus abdominis and its frontal sheath was kept and the free transverse inferior abdominis flap fed directly by deep inferior epigastric artery and its perforator was formed to reconstruct breast. The internal thoracic artery and venous of the same and contralateral side were used as recipients. The anastomoses site was taken at respective intercostals space according to the horizontal level of the reconstructed breast. The donor site was sewed up directly. Results 46 cases were undertaken breast reconstruction by DIEP flap. All of the 41 cases with double pedicle perforators survive. Among 5 cases with single pedicle perforator, 2 showed signs of lack of blood supply in distal range. After a follow-up of 5 months to 3 years, the reconstructed breasts showed satisfactory shape and quality. Conclusions Breast reconstruction bu using transverse rectus abdominis flap with Deep Inferior Epigastric Perforator (DIEP) is the most ideal technique with decreased donor site morbidity, abundant tissue amount and blood supply. DIEP flap could also be applied to repair other kinds of soft tissue defect. The application of this kind of flap represents the trend of flap transplantation in plastic surgery.