分叶游离下腹部皮瓣移植乳房再造的血管吻合方式选择

Selection of vascular anastomosis methods for breast reconstruction using lobed free lower abdominal flap transplantation

目的总结分叶游离下腹部皮瓣移植再造乳房的适应证和血管吻合方式选择。方法自2019年10月至2023年6月,在17例女性乳腺癌患者中完成分叶游离下腹部皮瓣移植乳房再造,包括10例即刻乳房再造和7例延期乳房再造。全部采用分叶游离下腹部皮瓣移植完成,包括M1型游离腹直肌皮瓣20侧,M2型6侧,M3型8侧。血管吻合方式具体包括:外增压方式9例,内增压方式8例。受区血管包括胸廓内血管近心端14侧,胸背血管主干10侧,前锯肌支3侧,胸外侧动静脉2例,胸廓内血管远心端5侧。结果每侧皮瓣长(14.2±0.4)cm、宽(11.5±1.0)cm、厚(4.9±0.3)cm。所有皮瓣血运良好,全部顺利成活。术后随访6~38个月,平均20.7个月,乳腺癌未见复发,再造乳房外形可,质地满意,无皮瓣挛缩变形,与健侧乳房外形基本对称;皮瓣供区及乳房受区仅遗留线性瘢痕,腹壁功能无明显影响。结论分叶游离下腹部皮瓣适用于底盘及垂度凸度都较大的乳房再造,选择合理的血管吻合方式可以确保皮瓣的自由摆放和满意的乳房塑形。

Objective To summarize the indications and vascular anastomosis methods selection for the transplantation of lobed free lower abdominal flap for breast reconstruction.Methods From October 2019 to June 2023,17 female breast cancer patients received lobulated free lower abdominal flap transfer for breast reconstruction,including 10 cases of immediate breast reconstruction and 7 cases of delayed breast reconstruction.All the cases were completed by transplantation of lobulated free lower abdominal flaps,including 20 M1 type free rectus abdominis skin flaps,6 M2 types,and 8 M3 types.The specific vascular anastomosis methods include supercharge in 9 cases and turbocharge in 8 cases.The recipient vessels include 14 sides of the proximal end of the internal mammary vessels,10 sides of the main trunk of the thoracodorsal vessels,3 sides of the serratus anterior branches,2 cases of the lateral thoracic artery and vein,and 5 sides of the distal end of the internal mammary vessels.Results Each side flap had a length of(14.2±0.4)cm,a width of(11.5±1.0)cm,and a thickness of(4.9±0.3)cm.All flaps had good blood circulation and all survived smoothly.All patients were followed up for 6 to 38 months(20.7 months on average),no recurrence was noted.The reconstructed breasts had good appearance,satisfactory texture,no flap contracture and deformation,and was basically symmetrical with the healthy breast.The flap donor site and breast recipient area only had linear scars left,and there was no significant impact on abdominal wall function.Conclusion The lobed free lower abdominal flap is suitable for breast reconstruction with large base and sagging convexity.Choosing a reasonable vascular anastomosis method can ensure the free placement of the flap and satisfactory breast shaping.