中国癌症杂志 ›› 2017, Vol. 27 ›› Issue (8): 626-633.doi: 10.19401/j.cnki.1007-3639.2017.08.005

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带蒂穿支皮瓣在乳房再造术中的应用

陈明华,曾 昂   

  1. 北京协和医院整形外科,北京 100730
  • 出版日期:2017-08-30 发布日期:2017-09-21
  • 通信作者: 曾 昂 E-mail: 13683507962@qq.com

Breast reconstruction with pedicled perforator flaps

CHEN Minghua, ZENG Ang   

  1. Plastic Surgery Department, Peking Union Medical College Hospital, Beijing 100730, China
  • Published:2017-08-30 Online:2017-09-21
  • Contact: ZENG Ang E-mail: 13683507962@qq.com

摘要: 与游离穿支皮瓣相比,带蒂穿支皮瓣分离技术更加简单,安全系数更高,而且供区畸形更小。近年来,应用带蒂穿支皮瓣技术已经成为乳房再造手术一种新的选择, 甚至是一些患者的首选方案。常用的带蒂穿支皮瓣有胸背动脉穿支皮瓣、肋间动脉穿支皮瓣(外侧肋间动脉穿支皮瓣、前侧肋间动脉穿支皮瓣)等,其他可用的选择包括前锯肌动脉穿支皮瓣,腹壁上动脉穿支皮瓣,胸外侧动脉穿支皮瓣等。为了提高手术设计的精确性,术前需要评估穿支血管的质量,并对其定位穿支。皮瓣的设计相比游离皮瓣手术而言,显得更加重要。虽然带蒂穿支皮瓣在乳房再造领域的作用尚不能取代游离皮瓣的金标准地位,但随着“损伤最小化”重建概念的日渐推广,带蒂穿支皮瓣将会成为乳房再造领域里的一种新的趋势。

关键词: 带蒂穿支皮瓣, 乳房再造, 穿支皮瓣, 胸背动脉穿支皮瓣, 肋间动脉穿支皮瓣, 前锯肌动脉穿支皮瓣, 腹壁上动脉穿支皮瓣, 胸外侧动脉穿支皮瓣

Abstract: Comparing with free perforator flap, pedicled flap is a relatively simpler and safer technique, with lesser donor site morbidity. In recent years, the application of pedicled perforator flaps has emerged as a new option for breast reconstruction. Those pedicled perforator flaps include thoracodorsal artery perforator flap, intercostal artery perforator flap (lateral intercostal artery perforator flap, anterior intercostal perforator flap) etc. Serratus anterior artery perforator flap, superior epigastric artery perforator flap, and lateral thoracic artery perforator flap can also be raised technically. To enhance surgical accuracy, it is necessary to evaluate the location and quality of perforator vessels preoperatively. Proper flap design is of more importance for pedicled flap when compared with it’s free flap counterpart. Although free flap approach remains the golden standard in breast reconstruction when considering autologous tissue transplantation, pedicled perforator flap has the apparent merits of minimized surgical trauma, less time-consuming and less stress for reconstructive surgeons.

Key words: Pedicel perforator flap, Breast reconstruction, Perforator flap, Thoracodorsal artery perforator flap, Intercostal artery perforator ?ap, Serratus anterior artery perforator ?ap, Superior epigastric artery perforator flap, Lateral thoracic artery perforator ?ap