双蒂腹壁下动脉穿支(DIEP)皮瓣的血供重建

Reconstruction of the Blood Supply on Double Pedicle Deep Inferior Epigastric Perforator (DIEP) Flap

目的提出3种双蒂腹壁下动脉穿支(Deep inferior epigastric perforator,DIEP)皮瓣重建血供的皮瓣内血管架桥的方法,并对3种方法进行比较。方法回顾了2004年1月到2008年12月,在我院行双蒂DIEP皮瓣乳房再造的病例共87例,38例采用远端法,20例采用侧支法,29例采用端侧法进行皮瓣内血管架桥,重建双蒂DIEP皮瓣血运。对3种方法的手术时间、术后血管危象、皮瓣坏死、皮瓣局部坏死和脂肪坏死的发生率进行统计学分析。结果 3种方法的皮瓣长度和宽度及手术时间均无统计学差异。术后随访6～60个月。2例远端法、1例侧支法和1例端侧法术后发生血管危象;没有病例发生皮瓣坏死,只有1例侧支法发生皮瓣局部坏死;远端法有3例、侧支法有4例、端侧法有4例在术后3个月发生脂肪坏死。结论使用远端法、侧支法和端侧法3种皮瓣内血管架桥的方法为双蒂DIEP皮瓣重建血运,是重建双蒂DIEP皮瓣血供较为理想的方法,适用于所有的血管条件。3种方法在手术时间、血管危象发生率和为皮瓣提供血运方面无明显差异。

Objective To introduce three different intra-flap anastomosis in reconstruction of the blood supply on double pedicle deep inferior epigastric perforator（DIEP） flap and to compare the outcomes of the three methods.Methods Eighty seven patients who received breast reconstruction by double pedicle DIEP flap in our department from January 2004 to December 2008 were reviewed.Three different intra-flap anastomosis in reconstruction the blood supply on double pedicle DIEP flap were performed.Thirty eight patients were performed the distal end to end anastomosis,20 patients were performed the lateral branch style and 29 patients were performed the end-to-side style.The operation time,postoperative vascular complications,flap loss,partial flap loss and fat necrosis of the three styles were analyzed.Results The length and width of the flap of the three groups had no statistical differences and so did the operation time.The follow up period ranged from 6 months to 60 months.2 patients of the distal end to end anastomosis,1 patient of the lateral branch style group and 1 patient of the end-to-side style group occurred postoperative vascular complications.There was no flap loss all of the three groups.One flap of the lateral branch style group developed partial flap loss.3 patients of the distal end to end anastomosis group,4 patients of the lateral branch style group and 4 patients of the end-to-side style group were found fat necrosis three months after operation.Conclusion The three styles of intra-flap anastomosis are all good methods for reconstruction of blood supply on double pedicle DIEP flap and can be used in all situations.The three methods have no differences in operation time,postoperative vascular complications and the capability of the blood supply of double pedicle DIEP flap reconstruction.