DIEP皮瓣个性化乳房再造术中塑形方法的介绍

Method for shaping of the deep inferior epigastric artery perforator flap in individualized breast reconstruction

目的探讨DIEP皮瓣在乳房再造术中的设计与塑形方法以及术后美学效果。方法对109例接受延期单侧行DIEP皮瓣乳房再造的乳腺癌患者,术中通过测量对侧乳房垂度及形态参数,镜像设计并塑形皮瓣;术后6个月利用计算机三维扫描技术对乳房对称性进行随访。结果参照健侧乳房形态和垂度,设计DIEP皮瓣半月形24例,半圆形42例,梭形43例。术后6个月计算机三维扫描结果显示,两侧乳房投影及乳头位置无明显差异。而与健侧相比,再造侧乳房具有较大的容积(P<0.01)和较高的凸度(P<0川),能够为乳头再造和瘢痕改形预留二期手术的空间。结论对于拟行自体组织乳房再造,但腹部组织量有限的女性患者,采用个性化DIEP皮瓣设计及塑形原则,可以最大程度地获得令人满意、对称的乳房美学效果,值得临床推广应用。

Objective To explore the efficacy of the deep inferior epigastric artery perforator （DIEP） flap in breast reconstruction and to introduce a well-established flap-shaping method and its aesthetic results. Methods From August 2012 to October 2015, a total of 109 breast cancer patients underwent delayed single breast reconstruction with DIEP flap in our hospital. The flap-shaping methods were quantitatively described and reconstructive outcomes were evaluated for asymmetry by a 3D scanning system at 6 months postoper- ative. Results In our series, based on the ptosis degree of the contralateral breast, 24 flaps were designed in a crescent shape, 42 flaps were designed in a semicircle shape, and 43 flaps were designed in a fusiform shape. The 3D scanning results showed that the discrepancy of the breast projection and nipple position did not differ significantly between the reconstructed and the normal breasts. However, the re- constructed side had significantly higher breast volume （P〈0.01） and projection （P〈0.01）, which leaves room for scar revision and nipple reconstruction. Conclusion For Asian patients with a relatively tight abdomen, the flap design and shaping approach we propose achieves a pleasing and maximally symmetrical outcome and should be considered as a good and reliable option.