前锯肌瓣在扩张后假体乳房再造术中的应用

Application of serratus anterior muscle flap transplantation in expander-based implant breast reconstruction

目的:研究前锯肌瓣在扩张后假体乳房再造术中的应用及其临床意义。方法:47例乳腺癌改良根治术或单纯乳腺切除患者(共47侧乳房)采用软组织扩张器并假体置入方式分期乳房再造,即扩张后假体置入乳房再造术(以下简称扩张乳房再造术),术式中均采用前锯肌瓣作为扩张器或假体外侧覆盖,观察一期及二期术后包膜挛缩、血清肿、血肿、切口裂开及感染等并发症发生情况。结果:所有观察病例中,一期扩张器置入术后(47例)无血肿发生,无感染,无切口或皮瓣坏死,2例(2侧)切口裂开;二期假体更换后(46例),无血肿发生,无感染,无切口或皮瓣坏死,无切口裂开,平均随访(465.0±2.5)d,随访期间未见包膜挛缩病例。结论:扩张后假体乳房再造术中运用前锯肌瓣能较好地固定扩张器及假体,减少并发症,防止假体移位,获得好的乳房形态。

Objective：To study the application of serratus anterior muscle flap transplantation in expander-based implant breast reconstruction and its clinical significance. Methods：Forty-seven breast cancer patients received modified radical mastectomy or mammectomy （a total of 47 breast） were enrolled. They have taken staging breast reconstructoin using soft tissue expanders （SRTX）. Then the clincal results have been observed,recorded and analyzed. The serratus anterior muscle flap was used as lateral coverage in the operation. The complications such as postoperative capsular contracture,seroma,hematoma,incision dehiscence and infection have been recorded in both periodⅠ and periodⅡ operations. Results：Of all patients （47 cases）,there was no complication such as hematoma,infection,or skin flap necrosis happened during the follow up after periodⅠ and periodⅡ operations. Only 2 cases （2 sides） had incision dehiscence after periodⅠ. During the follow-up period（465.0 ± 2.5） days,no capsular contracture happened. Conclusion：Using anterior serratus muscle flap in expander-based implant breast reconstruction can fix the expander and implant,reduce complications,prevent breast implant displacement and create good breast shape.