股薄肌皮瓣联合大收肌穿支皮瓣在乳房重建中的应用

Application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction

目的探讨股薄肌皮瓣联合大收肌穿支皮瓣在乳腺癌术后乳房重建中的应用及疗效。方法 2016年8月—2017年2月,应用股薄肌皮瓣联合大收肌穿支皮瓣对12例乳腺癌患者行乳房重建。患者均为女性;年龄32～59岁,平均41.5岁。左侧7例,右侧5例。一期乳房重建8例,病理诊断为浸润性导管癌4例、浸润性小叶癌4例;病程2～9个月,平均4.5个月。二期乳房重建4例,乳腺癌改良根治术至该次手术时间为12～70个月,平均37.4个月。术中切取股薄肌皮瓣联合大收肌穿支皮瓣长20～28 cm、宽5.5～7.5 cm、厚2.5～4.5 cm;股薄肌皮瓣血管蒂长度为6.5～9.2 cm、大收肌穿支皮瓣血管蒂长度为7.5～10.4 cm;皮瓣质量为295～615 g。结果术中皮瓣缺血时间为95～230 min,平均135 min。术后皮瓣均顺利成活,供受区切口均Ⅰ期愈合。12例患者均获随访,随访时间7～14个月,平均9.5个月。再造乳房外形可、弹性好,无皮瓣挛缩变形。腿部供区仅遗留线性瘢痕,腿部功能无明显受限。随访期间肿瘤无复发。结论股薄肌皮瓣联合大收肌穿支皮瓣可作为乳腺癌术后乳房重建的选择之一。

Objective To explore the clinical application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction of breast cancer patients after mastectomy. Methods Between August2016 and February 2017, the combined transverse upper gracilis flap and adductor magnus perforator flap was used in 12 cases of breast cancer patients who received modified radical surgery for breast reconstruction. All patients were females with the age of 32 to 59 years（mean, 41.5 years）. There were 7 cases in left side and 5 cases in right side. Eight cases were received breast reconstruction by one-stage operation and 4 cases by two-stage operation. In one-stage operation cases,pathological diagnosis includes invasive ductal carcinoma in 4 cases and invasive lobular carcinoma in 4 cases. The disease duration ranged from 2 to 9 months（mean, 4.5 months）. In two-stage operation cases, the time interval between mastectomy and breast reconstruction ranged from 12 to 70 months（mean, 37.4 months）. The length of flap was 20-28 cm, the width of flap was 5.5-7.5 cm, the thickness of flap was 2.5-4.5 cm. The length of gracilis flap pedicle was 6.5-9.2 cm, the length of adductor magnus perforator flap pedicle was 7.5-10.4 cm. The weight of flap was 295-615 g.Results The ischemia time of flap ranged from 95 to 230 minutes（mean, 135 minutes）. All flaps were successfully s urvived. All incisions of recipient donor sites healed by first intention. All patients were followed up 7-14 months（mean,9.5 months）. The reconstructed breasts＇ shape, texture, and elasticity were good and no flap contracture deformation happened. Only linear scar left in the donor sites, but the function of thighs was not affected. No local recurrence happened during follow-up. Conclusion With appropriate patient selection and surgical technique, the combined transverse upper gracilis flap and adductor magnus perforator flap can be a valuable option as an alternative method for autologous breast reconstruction.