背阔肌肌皮瓣联合假体在乳腺癌改良根治术后即刻乳房重建中的应用

Application of latissimus dorsi flap combined with prosthesis in immediate breast reconstruction after modified radical mastectomy

目的探讨背阔肌肌皮瓣联合假体在乳腺癌改良根治术后即刻乳房重建中的应用效果。方法自2016年1月至2019年12月,应用背阔肌肌皮瓣联合假体进行乳腺癌改良根治术后即刻乳房重建16例。回顾该方法一期术前准备、术中设计、手术过程、术后随访、二期乳头乳晕再造和局部修整过程,分析并发症发生原因并提出改进措施。结果所有病例成功完成一期重建手术,2例患者完成二期乳头、乳晕再造和脂肪移植手术。手术并发症包括供瓣区血清肿、残余乳房皮瓣边缘坏死等,再造乳房外观缺陷包括上极不饱满、下皱襞不对称、瘢痕增生挛缩等。通过VAS量表评价再造乳房外观患者满意度,非常满意8例,满意5例,不满意3例。结论背阔肌肌皮瓣联合假体一期重建乳房效果可靠,二期进行乳头、乳晕再造和脂肪移植修整后能取得良好效果。

Objective To explore the application of latissimus dorsi(LD)flap combined with prosthesis in immediate breast reconstruction after modified radical mastectomy.Methods From Jan.2016 to Dec.2019,16 patients underwent immediate breast reconstruction using LD flap combined with prosthesis.The preoperative preparation,surgical design,surgical procedure,and follow⁃up result were analyzed.The reconstruction of nipple⁃areola complex and the application of fat transplantation were also introduced.The complications were summarized and the improvement measures were put forward.Results All patients had successful immediate breast reconstruction and two of them received the reconstruction of nipple⁃areola complex and fat transplantation.The post⁃operative complications included seroma in donor site and marginal necrosis in residual breast flap.The flaws of reconstructed breasts included collapse upper pole,submammary fold asymmetry,scar hyperplasia,etc.With the evaluation by visual analog scale(VAS),8 cases were graded as complete satisfaction,5 cases were graded as satisfaction,and 3 cases were graded as dissatisfaction.Conclusion LD flap combined with prosthesis is a reliable method for immediate breast reconstruction.After NAC reconstruction and fat transplantation,the appearance of reconstructed breast can be pretty well.