双侧游离股深动脉穿支皮瓣即刻乳房再造一例报告并文献复习

Bilateral free profunda artery perforator flaps（PAP） for immediate unilateral breast reconstruction：a case report and review of literature

目的：探讨对于不适合应用腹部及背部皮瓣进行自体乳房再造的患者，使用股深动脉穿支（PAP）皮瓣进行乳房再造的可行性。方法2016年8月，我院对1例34岁患左侧乳腺癌的女性患者，术前应用便携式Doppler血流探测仪定位双侧股深动脉穿支血管位置，于乳腺癌切除手术同时即刻行双侧游离股深动脉穿支皮瓣乳房再造，术中所取右侧PAP皮瓣18 cm x5 cm，左侧PAP皮瓣20 cmx5 cm，双侧血管蒂长约6 cm，动脉直径约2．2 mm，右侧股深动脉穿支动静脉与左侧胸背动静脉行端-端吻合，左侧股深动脉穿支动静脉与左侧胸廓内动静脉近心端行端-端吻合。结果患者病理：乳腺高级别导管原位癌，前哨淋巴结未见癌转移（0／4）。患者双侧股深动脉穿支皮瓣全部成活，未见缺血坏死、感染等并发症，患者术后5d下地活动，术后1周出院，随访1个月，恢复良好，双下肢活动未受影响，患者自身对于再造乳房及供区恢复均满意。结论游离股深动脉穿支皮瓣因其血供恒定及供区隐蔽，可以作为除腹部及背部皮瓣以外乳房再造的另一个良好的供区选择。

Objective To investigate the possibility of using the profunda artery perforator flap （PAP） for breast reconstruction cases who are not the good candidates for back and abdominal donor sites. Methods This case was a breast cancer patient who required an i mmediate breast reconstruction with autologous tissue,skinny, bi-lateral severe breast atrophy and mastoptosis after lactation, twice cesarean delivery and umbilical hernia in August, 2016. Portable Doppler was used to detect the profunda artery perforator. The donor sites were designed according to the tissue defect after the mastectomy. The incisions were designed near to the inferior gluteal folds and medial gluteal areas. The left PAP flap was 20 cm ＆#215; 5 cm, and the right PAP flap was 18 cm ＆#215; 5 cm. The pedicles length of the both flaps were about 6.0 cm, and the perforator artery diameter of the both flaps were 2.2 mm. The right PAP vessels were connected to the left thoracodorsal vessels with end-to-end anastomosis. The left PAP vessels were connected to the proximal part of left internal ma mmary vessels with end-to-end anastomosis. The indocyanine green angiogra-phy under microscope showed the signs of patency in all the vessel anastomosis. Results The intraoperative patho-logic diagnosis was extensive intraductal carcinoma, and the sentinel lymph nodes biopsy showed negative result. The re-constructive breast has a nice appearance, natural and proper IMF. Both of the PAP flaps survive 100%, and the donor sites healed well and remained inconspicuous. The patient can walk freely on the 5th day postoperative, and back to home on the 7th day. Within the follow-up for one month, the patient was very satisfied with the new breast and a better gluteal appearance. Conclusion The free PAP flaps provide an excellent alternative to an ab-dominal and back donor sites for achieving the breast reconstruction due to the relaible supplying pedicle vessels and invisible donor scars.