双血管蒂腹壁下动脉穿支皮瓣在即刻乳房重建中的应用

Bipedicle deep inferior epigastric perforator flaps for immediate breast reconstruction

目的探讨双血管蒂腹壁下动脉穿支皮瓣在即刻乳房重建中的临床应用效果。方法回顾性分析2023年5月至2023年9月收治的6例行双血管蒂腹壁下动脉穿支皮瓣即刻乳房重建患者的临床资料。患者平均年龄39.17(30~47)岁,体重指数(body mass index,BMI)22.2~26.5 kg/m^(2)。2例患者行保留乳头乳晕的全乳切除术,4例患者行保留皮肤的全乳切除术;4例患者行腋窝淋巴结清扫术,2例患者行前哨淋巴结活检术;6例患者均行双血管蒂腹壁下动脉穿支皮瓣即刻乳房重建术。结果切取供区皮瓣大小20 cm×10 cm~26 cm×14 cm,皮瓣厚度2.8~4.0 cm,手术时间473~690 min。6例皮瓣术后全部成活,无明显并发症出现。术后复查,6例患者均乳房外形及对称性良好,乳房质地柔软,患者满意度高。结论使用双血管蒂腹壁下动脉穿支皮瓣即刻重建乳房,手术安全性高,术后乳房外形美容效果及乳房质地好,患者满意度较高。本术式适用于健侧乳房较大,或根治术后胸壁缺损较大,或腹壁脂肪量相对较少,或腹部有竖切口手术史的患者。

Objective To investigate the clinical effect of the application of bipedicle deep inferior ep-igastric perforator(DIEP)flap in immediate breast reconstruction.Methods The clinical data of 6 patients who underwent immediate breast reconstruction with bipedicle deep inferior epigastric perforator flaps from May 2023 to September 2023 were retrospectively analyzed.The baseline data,operation information,operative complications,cosmetic effects of breast appearance,breast texture,appearance of abdominal donor area,and degree of satisfaction by patients were collected and analyzed.Results The age of the 6 patients ranged from 30 to 47 years,with an average age of 39.17 years.Body mass index(BMI)ranged from 22.2 to 26.5 kg/m^(2).The size of the flap ranged from 20 cm×10 cm to 26 cm×14 cm,and the thickness of the flap ranged from 2.8 cm to 4.0 cm.The operation time ranged from 473 to 690 min.All 6 cases of flaps survived,and no obvious operative complications occurred.All the 6 patients were satisfied with the aesthetic outcomes and soft tactility of the breast.Conclusions Immediate breast reconstruction with bipedicle deep inferior ep-igastric perforator flap can be performed safely and can achieve satisfied cosmetic effects.It is suitable for patients with large breast on the healthy side,large chest wall defect,thin abdominal wall fat,or abdomi-nal surgical history.