带蒂穿支皮瓣在乳房再造术中的应用

Breast reconstruction with pedicled perforator flaps

与游离穿支皮瓣相比,带蒂穿支皮瓣分离技术更加简单,安全系数更高,而且供区畸形更小。近年来,应用带蒂穿支皮瓣技术已经成为乳房再造手术一种新的选择,甚至是一些患者的首选方案。常用的带蒂穿支皮瓣有胸背动脉穿支皮瓣、肋间动脉穿支皮瓣(外侧肋间动脉穿支皮瓣、前侧肋间动脉穿支皮瓣)等,其他可用的选择包括前锯肌动脉穿支皮瓣,腹壁上动脉穿支皮瓣,胸外侧动脉穿支皮瓣等。为了提高手术设计的精确性,术前需要评估穿支血管的质量,并对其定位穿支。皮瓣的设计相比游离皮瓣手术而言,显得更加重要。虽然带蒂穿支皮瓣在乳房再造领域的作用尚不能取代游离皮瓣的金标准地位,但随着"损伤最小化"重建概念的日渐推广,带蒂穿支皮瓣将会成为乳房再造领域里的一种新的趋势。

Comparing with free perforator fap, pedicled fap is a relatively simpler and safer technique, with lesser donor site morbidity. In recent years, the application of pedicled perforator faps has emerged as a new option for breast reconstruction. Those pedicled perforator faps include thoracodorsal artery perforator fap, intercostal artery perforator fap （lateral intercostal artery perforator fap, anterior intercostal perforator fap） etc. Serratus anterior artery perforator fap, superior epigastric artery perforator fap, and lateral thoracic artery perforator fap can also be raised technically. To enhance surgical accuracy, it is necessary to evaluate the location and quality of perforator vessels preoperatively. Proper fap design is of more importance for pedicled fap when compared with it’s free fap counterpart. Although free fap approach remains the golden standard in breast reconstruction when considering autologous tissue transplantation, pedicled perforator fap has the apparent merits of minimized surgical trauma, less time-consuming and less stress for reconstructive surgeons.