乳晕浅深层旋转三角形皮瓣和筋膜组织瓣治疗重度乳头内陷

目的 探讨矫正女性重度乳头内陷的手术治疗新方法.方法 首先在乳头区中央部标出重建乳头顶部位,再于其上、下两侧乳晕部分别设计浅深层的带蒂旋转三角形皮瓣和筋膜组织瓣,厚度约0.5 cm.皮瓣的血供来自乳晕皮下动脉网;筋膜组织瓣的血供来自乳腺深部.深层组织瓣经乳头基底部隧道水平推进或向上推进,以改善颈部高度和宽度,并加强其支撑力量.浅层三角形皮瓣顺时针旋转推进并包绕颈部,以使乳头颈充分成形.结果 全部病例术后伤口均愈合良好,康复快,没有出现血肿、感染和血运障碍所致的乳头坏死等并发症.随访3～6个月,患者均对乳头外形感到满意,无复发.结论 乳晕浅深层旋转三角形皮瓣和筋膜组织瓣法是矫正重度乳头内陷和术后复发的一种较好手术治疗方法,有推广应用价值.

Triangular flaps and fascia-tissue flaps rotation for correction of severe inverted nipple in shallow and deep areola of breast

Objective To explore a new methodology for surgical treatment of severe retracted nipple in women. Methods 20 patients with inverted nipple and 4 recurred patients were involved in this study. Firstly, the site of neonipple tip was marked in the central part of the inverted nipple and its mean diameter usually was 1.2-1.5 cm. Then two shallow and deep triangular pedicled flaps were designed, respectively, in both superior and inferior areas near areola. With temporary traction of the nipple apex provided by a stay suture, the fibrotie bands underneath the nipple base might be cautious-ly released. Moreover, the shallow skin flaps should be about 0.5 cm in thickness and their blood sup-ply was from the subdermal arterial rete of the areola, which were used to cover and reconstruct the neck area of neonipple after a clockwise rotation and advancement simultaneously. While the deep fas-cia tissue flaps were revolved and advanced either horizontally to the opposite pedicle or upward to the inner tip through the tunnel underneath the nipple base in order to improve the height or width of the neonipple neck and prevent flattening as the supporting tissue and their blood supply was from some small perforating branch arteries in the deep part of mammary gland. Finally, purse-string suture was necessary in the base of neonipple which played a key role in avoiding recurrence of nipple inversion. Four vertical diamond-shaped excision-suturation treatment in neck area could make improvemts on the height of those stout and short nipples. Results In all 24 cases corrected by shallow and deep triangu-lar flaps rotation, after 3-6 months' follow-up, there were no complications related to surgery such as infection, hematoma, permanent sensory disturbance, or nipple necrosis, and postoperative recovery was rapid and uneventful. Especially, follow-up data revealed no evidence of recurrence of inversion and all patients were satisfied with their results. Conclusions Triangular flaps and fascia-tissue flaps in shallow and deep areola rotation is effective and easy to be popularized in correction of inverted nip-ple. This technique can improve both the diameter and height of the nipple, and certainly lower the re-currence rate of nipple inversion and achieve good aesthetic results.