双侧腹壁浅动脉穿支皮瓣移植再造1例单侧乳腺癌患者乳房

Transplantation of bilateral superficial inferior epigastric artery perforator flap for breast reconstruction in a patient with unilateral breast cancer

2020年5月14日,湖南省肿瘤医院收治1例37岁女性单侧乳腺癌患者,对其行右侧乳腺癌改良根治+双侧腹壁浅动脉穿支皮瓣(重量为305 g)游离移植再造乳房。术中将右侧腹壁下血管蒂与右侧胸廓内血管近端吻合、左侧腹壁下血管蒂与右侧胸廓内血管远端吻合,见皮瓣通血良好,将腹部皮瓣供区创面直接拉拢闭合。手术历时9 h。术后第1个48 h皮瓣显示轻度灌大于流,未见明显水肿或水疱,皮瓣温度与周围皮肤一致,引流管引流量仅40 mL。术后3 d皮瓣血运完全恢复正常,皮瓣存活良好,供区切口无明显张力,愈合顺利。随访2个月,腹部供区切口完全愈合,仅遗留线性瘢痕,重建乳房外形自然,患者计划进一步行乳头重建和对侧乳房悬吊术。该病例提示在特定情况下可选用双侧腹壁浅动脉穿支皮瓣进行自体乳房再造,以最大限度减少供区损伤。

On May 14,2020,a 37 year old female patient with unilateral breast cancer was admitted to Hunan Cancer Hospital.She underwent modified radical mastectomy for right breast cancer and free transplantation of bilateral superficial inferior epigastric artery perforator flap(weighed 305 g)for breast reconstruction.During the operation,the right inferior epigastric vascular pedicle was anastomosed with the proximal end of the right internal mammary vessel,and the left inferior epigastric vascular pedicle was anastomosed with the distal end of the right internal mammary vessel;the blood flow of the flap was good;the wound in the donor site of the abdominal flap was closed directly.The operation lasted for 9 hours.In the first 48 hours post operation,the flap showed mild elevation in perfusion over drainage,but no obvious edema or blister was observed,flap temperature was consistent with the surrounding skin,and the drainage volume out of drainage tube was only 40 mL.The blood supply of the flap was completely restored to normal 3 days post operation,the flap survived well,the donor site incision had no obvious tension,and the healing was smooth.After 2 months of follow-up,the donor site incision of abdomen healed completely,only linear scar was left,and the reconstructed breast had a natural appearance;the patient planned to perform further nipple reconstruction and contralateral breast mastopexy.This case suggests that autologous breast reconstruction can be performed using bilateral superficial inferior epigastric artery perforator flaps under certain circumstances to minimize donor site injury to the greatest extent.