交叉菱形真皮瓣联合乳头持续牵引矫正乳头内陷的临床效果观察

Effect of cross rhomboid dermal flaps combined with continuous traction for correction of inversed nipple

目的 探讨交叉菱形真皮瓣联合乳头持续牵引矫正乳头内陷的临床效果.方法 选择2008年4月至2014年2月于北京大学人民医院就诊的乳头内陷患者30例（56个乳头）,双侧乳头内陷26例,单侧乳头内陷4例.采用乳晕交叉菱形真皮瓣支撑内陷的乳头基底,同时松解牵拉乳头的纤维结缔组织,缩窄乳头颈部矫正乳头内陷,术后采用自制乳头牵引器牵拉乳头4～8周.结果 30例患者术后均未出现感染、血肿、乳头坏死、乳头永久性感觉丧失等并发症.术后随访6 ～38个月,24例患者（47个乳头）内陷完全矫正,乳头感觉正常,4例患者（7个乳头）由重度内陷转为轻度内陷,2例（2个乳头）复发,通过再次牵引得以矫正,5例术后妊娠患者哺乳正常.结论 乳晕交叉菱形真皮瓣联合乳头持续牵引矫正乳头内陷方法简单,能获得良好的外形,且复发率低,对乳管损伤小,患者耐受度高.

Objective To explore the effect of cross rhomboid dermal flaps combined with continuous traction in correcting nipple inversion.Methods Totally 30 cases with inversed nipple （56 nipples）,including 26 cases of bilateral insersed nipple and 4 cases of unilateral insersed nipple from April 2008 to February 2014 were selected.Cross rhomboid dermal flaps of mammary areola was used to support the basement of the inverted nipple,the fibrous connective tissue that pulling the nipple was released,then the cervix of nipple was constricted to correct.Continuous nipple retraction and homemade tractor was used to pull the postoperative nipple for 4 weeks to 8 weeks.Results There was no complication occurred after operation,such as infection,hematoma,nipple necrosis,and permanent loss of sensation of the nipple.All cases were followed up for 6-38 months,24 cases （47 nipples） acquired full correction and normal sense after the procedure,4 cases （7 nipples） acquired partial correction,and 2 recurrent cases （2 nipples） were cured after re-traction.Five patients of pregnancy underwent normal breast-feeding.Conclusions The cross rhomboid dermal flaps and continuous traction technique is a simple,reliable method for correcting nipple inversions;the advantages are low recurrence rate,less damage to the galatophore and high patient tolerance.