应用腹直肌皮瓣修复乳癌放疗后放射性溃疡

Rectus abdominis flap repairing radiation ulcer after radiationtherapy for breast cancer

目的:探讨腹直肌肌皮瓣在乳癌放射性治疗(以下简称放疗)后放射性溃疡修复中的应用。方法:2007年以来应用健侧单蒂腹直肌肌皮瓣转移修复乳癌放疗后放射性溃疡16例。9例采用纵行腹直肌肌皮瓣,其中3例合并臂丛神经损伤的患者为其行臂丛神经松解术并局部注射间充质干细胞;7例采用横行腹直肌肌皮瓣修复,其中4例同时行乳房再造术。结果:1例患者皮瓣远端部分坏死,清创术后采用局部皮瓣修复;2例术后出现皮瓣下渗出积液,手术予以再次清创。其余皮瓣成活良好,创面修复满意。结论:腹直肌肌皮瓣血运可靠,是修复乳癌放疗后放射性溃疡的一种较为有效、简单和安全的方法,应根据具体的病变程度、范围设计适宜的肌皮瓣转移方式。

Objective To explore the application and significance of the rectus abdominis flap on chronical ulcer after radiationtherapy for breast cancer. Methods The uni-pedical rectus abdomis flap of uninjured side was applied to restore the radiation ulcer in16 patients. 9 cases were performed with longitudinal rectus abdominis flap. 3 cases with radiationinduced-brachial plexus nerve of them were performed with neurolysis and injected with mesenchymal stem cells（abbr. for MSC）simultaneously. 7 cases were performed with transverse rectus abdominis flap（abbr. for TRAM）. Of them, 4 csses were breast reconstructed. Results All the flaps were survived successfull except one with little necrosis on edge, which were cured with local flap after debridement and the other 2 cases with hydrops and exudation under flap, which were cured with debridement once again. Conclusion Rectus abdominis flap is effective and simple reconstructive option for radiation ulcer. And eligible mode of flap transposition should vary with practical characteristic of lesion.