论文部分内容阅读
目的:探讨移植内增压式双侧血管蒂腹壁下动脉穿支皮瓣行乳房再造的临床效果。方法:采用回顾性观察性研究。2008年12月—2016年12月湖南省肿瘤医院整形外科收治24例符合入选标准的乳腺癌术后患者，均为女性，年龄28~51（36.5±1.6）岁，均采用内增压式双侧血管蒂腹壁下动脉穿支皮瓣行Ⅱ期乳房再造。根据内增压吻合血管类型，将内增压式双侧血管蒂腹壁下动脉穿支皮瓣分为3种类型：吻合血管蒂主干远端型、吻合血管蒂主干主要分支型和吻合血管蒂肌支型。皮瓣长（27.5±0.3）cm、宽（12.8±1.4）cm。供瓣区予以彻底止血后，间断缝合修补前鞘，完成脐重建，留置2根负压引流管，逐层缝合皮下组织及皮肤。皮瓣血管蒂与受区胸廓内血管吻合具体方式包括吻合1支动脉和1支静脉近端、吻合1支动脉和1支静脉近远端、吻合1支动脉和2支静脉近端。术后观察皮瓣成活、血运情况。随访观察再造乳房外形满意度、供区并发症、腹壁功能及瘢痕增生情况。结果:术后，采用内增压式双侧血管蒂腹壁下动脉穿支皮瓣行Ⅱ期乳房再造术患者的皮瓣均顺利成活且血运良好。随访14~56（20±6）个月，患者再造乳房外形满意，腹部供区无并发症且仅遗留线性瘢痕，腹壁功能无明显受限。结论:对有明确适应证的患者行游离内增压式双侧血管蒂腹壁下动脉穿支皮瓣移植，是自体组织乳房再造安全可靠、效果满意的选择方案。“,”Objective:To explore the clinical effects of transplantation of turbocharged bipedicle deep inferior epigastric perforator (DIEP) flap in breast reconstruction.Methods:A retrospective observational study was used. From December 2008 to December 2016, 24 patients who met the inclusion criteria were treated in the Department of Plastic Surgery of Hunan Cancer Hospital, all patients were female, aged 28-51 (36.5±1.6) years. All cases received turbocharged bipedicle DIEP flap for two-staged breast reconstruction. According to the patterns of turbocharged vessels anastomosis, the turbocharged bipedicle DIEP flaps with length of (27.5±0.3) cm and width of (12.8±1.4) cm, were divided into three types: distal end of pedicle anastomosis type, main branch of pedicle anastomosis type, and muscular branch of pedicle anastomosis type. After complete hemostasis in the donor region, the anterior sheath was repaired with intermittent suture, and umbilical reconstruction was completed. Two negative pressure drainage tubes were indwelled, and subcutaneous tissue and skin were sutured layer by layer. The specific ways of vascular anastomosis of the flap pedicle with the internal thoracic vessels of recipient site included anastomosing the proximal end of one artery and one vein, anastomosing the proximal and distal end of one artery and one vein, and anastomosing the proximal end of one artery and two veins. Postoperatively, the survival and blood supply of flaps were observed. The patients were followed up to observe the reconstructed breast shape satisfaction, donor site complications, abdominal wall function, and scar hyperplasia.Results:All turbocharged bipedicle DIEP flaps for two-staged breast reconstruction survived well, with good blood supply. During follow-up for 14 to 56 (20±6) months, the shape of reconstructed breasts was satisfied. Only linear scar was left in the donor sites of abdomen with no complications, and the function of abdominal wall was not affected.Conclusions:For patients with clear indications, transplantation of free turbocharged bipedicle DIEP flap is a safe, reliable, and satisfactory choice for breast reconstruction with autologous tissue.