应用腹壁下动脉穿支皮瓣再造阴道

目的探讨应用腹壁下动脉穿支皮瓣再造阴道的优缺点。方法2004年1月~2005年5月,采用腹壁下动脉穿支(deepinferiorepigastricperforator,DIEP)皮瓣再造阴道5例,年龄19~40岁。先天性无阴道4例,阴道肿瘤1例。术前常规用超声多普勒检测DIEP,设计10cm×9cm~12cm×11cm的菱形皮瓣,将穿支点包括在皮瓣内。皮瓣切取后作内翻缝合成皮筒状,于腹股沟韧带与耻骨之间沿耻骨结节及耻骨上支内侧面,形成皮筒通过的隧道。将阴道皮筒经隧道移位至人工阴道腔隙或阴道肿瘤切除后的创面中再造阴道。结果5例阴道再造均获得成功,1例患者术后2周出现阴道后壁血肿,经清除血肿后愈合。腹壁供区无任何并发症发生。术后随访1~6个月,再造阴道质地柔软,宽敞,3例有性生活,患者感觉满意。结论应用DIEP皮瓣再造阴道是一种较理想的术式,对广泛的阴道肿瘤切除,由于需填充较多组织,仍是较好选择。     

应用腹壁下动脉穿支皮瓣再造乳房

目的对应用腹壁下动脉穿支(deepinferiorepigastricperforator,DIEP)皮瓣进行乳房再造进结。方法2000年3月~2005年3月,收治18例患者,其中因乳腺癌导致乳房缺损17例,术前行放射治疗者7例放射治疗者10例;先天性Poland’s综合征1例。胸壁缺损范围12cm×8cm~25cm×20cm。应用DIEP皮瓣游离进行乳房再造,皮瓣切取范围12cm×8cm~35cm×22cm。15例乳房再造患者使用的受区血管是胸廓内血管,其中腹壁下动、静脉分别与切断后的胸廓内动、静脉近、远心端行吻合者13例;仅切取一侧腹壁下血管,与胸廓内动、静心端行吻合者2例。3例行即刻乳房再造者使用的受区血管分别是胸背动、静脉和胸背动、静脉加旋肩胛动、静脉。18例患者中16例术后皮瓣全部成活,2例术后出现皮瓣坏死。其中行放射治疗1例,未行放射治疗1例。Poland合征患者术后皮瓣远端约1/3面积坏死。术后半年行乳头再造和乳房修整者2例。2例术后2周出现腹部供瓣区正口部分裂开,行创面清创后,分别应用直接缝合和植皮的方法进行修复。结论DIEP皮瓣在保留了传统下腹部横直肌皮瓣乳房再造所具有的优点同时,可最大限度保留腹直肌的功能,从而避免术后出现腹壁薄弱、腹壁疝等并发目前较理想的乳房再造方式。     

腹壁下动脉穿支皮瓣修复腹部创面

目的探讨应用腹壁下动脉穿支皮瓣修复腹部创面的方法。方法2001年12月至2006年12月,对9例腹部创面,其中3例伴腹壁缺损的患者,用腹壁下动脉穿支皮瓣进行修复,供区直接缝合。结果本组9例腹壁下动脉穿支皮瓣全部Ⅰ期愈合。随访6~12个月,外形良好,均无腹壁疝和腹内疝的发生。结论腹壁下动脉穿支皮瓣是修复腹部创面合理、可靠的新方法,手术简单,易于普及推广。     

腹壁下动脉穿支皮瓣修复腹部创面

目的探讨应用腹壁下动脉穿支皮瓣修复腹部创面的方法。方法2001年12月至2006年12月,对9例腹部创面,其中3例伴腹壁缺损的患者,用腹壁下动脉穿支皮瓣进行修复,供区直接缝合。结果本组9例腹壁下动脉穿支皮瓣全部Ⅰ期愈合。随访6-12个月,外形良好,均无腹壁疝和腹内疝的发生。结论腹壁下动脉穿支皮瓣是修复腹部创面合理、可靠的新方法,手术简单,易于普及推广。     

游离腹壁下深动脉穿支皮瓣一期重建乳房

目的　行乳癌改良根治术同时应用游离腹壁下深动脉穿支 (deepinferiorepigastricper forator,DIEP)皮瓣行一期乳房再造 ,以降低术后并发症的发生率。方法　 2 0 0 1年 12月～ 2 0 0 3年 1月对 12例患单侧乳癌的女性患者 ,在行乳癌改良根治术的同时用游离DIEP皮瓣行一期乳房再造 ,受区血管采用胸背动、静脉或胸廓内动、静脉。结果　本组 12例DIEP皮瓣中有 1例因为下腹部多条瘢痕 ,术后整块皮瓣坏死 ,其余 11例全部存活。 11例再造乳房和对侧乳房大小基本一致 ,术后无一例发生腹壁薄弱、腹部包块、腹壁疝等。结论　DIEP皮瓣是利用自体组织一期重建乳房合理可靠的新方法 ,较TRAM皮瓣 ,术后供区的并发症明显降低 ,康复快 ,但手术较复杂、时间较长 ,对外科技术的要求较高。     

腹壁下动脉穿支皮瓣游离移植修复四肢软组织缺损

目的：报告腹壁下动脉穿支皮瓣游离移植修复四肢组织缺损临床应用结果。方法：自2006年1月至2012年1月,应用腹壁下动脉穿支皮瓣带蒂移植修复小腿（7例）和前臂（6例）软组织缺损13例,其中男9例,女4例;年龄21-45岁,平均33岁。软组织缺损范围7 cm×17 cm-8 cm×26 cm。外侧支和内侧支穿支皮瓣分别是7例和6例。供区直接缝合。结果：1例皮瓣发生小的皮缘裂开,术后1个月自然愈合,皮瓣全部成活。术后随访1.8-4.0年,平均2.8年,受区外形较好。结论：腹壁下动脉穿支皮瓣游离移植很适宜修复四肢软组织缺损,这种技术安全、可靠,可降低对供区的损伤。     

腹壁下动脉穿支皮瓣血管穿支及感觉神经的应用解剖

目的　为腹壁下动脉穿支 (deepinferiorepigastricperforator,DIEP)皮瓣感觉的修复提供解剖学依据。方法　对 9具 18侧常规防腐固定的成年女尸腹前外侧壁进行详细解剖学研究。结果　腹壁下动脉穿支主要位于腹直肌鞘区 ,平均每侧 17 5支 ,直径≥ 0 5mm者 7 8支 ,直径≥ 0 5mm者 9 7支 ,其中皮瓣上半部最多 ,内侧略多于外侧。DIEP皮瓣主要位于T9～T12神经节段范围内 ,5 6 2 %DIEP有感觉神经穿支伴行 ,而粗大DIEP的感觉神经伴行率高达 80 .9%。结论　切取以腹壁下动脉穿支为血供来源、以肋间神经感觉支为感觉支配的DIEP皮瓣时 ,穿支选择应以脐周外侧粗大神经血管束为首选。     

游离腹壁下动脉穿支皮瓣在乳房再造中的应用

目的:探讨游离腹壁下动脉皮肤穿支(deep inferior epigastric perforator,DIEP)皮瓣在早期乳腺癌患者(Ⅰ或Ⅱ期)术后乳房再造中的临床应用。方法:对12例早期乳腺癌患者行根治术或改良根治术同期或二期应用DIEP皮瓣行乳房再造,其中乳腺癌分期I期9例,II期3例。结果:1例皮瓣出现部分坏死,1例皮瓣出现脂肪液化,经换药后愈合,其余皮瓣均成活,再造乳房外形可,弹性好,无皮瓣挛缩变形;无腹壁疝和腹壁膨出。11例获随访平均2.2年,效果均较满意,未出现乳腺癌复发病例,4例获得优,5例获得良,失访1例按良计算,2例效果差,优良率83.3%。结论:乳腺癌术后一期或二期应用DIEP皮瓣游离移植再造乳房,具有皮瓣血运良好、再造乳房外形满意、腹部供区并发症少,可同时行腹壁整形等优点,是乳腺癌术后乳房再造的理想方法之一,放化疗不影响皮瓣的成活。     

以双蒂腹壁下动脉穿支皮瓣再造乳房

目的 报道对有纵形剖腹产瘢痕的乳腺癌根治术后所造成的胸壁畸形，应用双蒂腹壁下动脉穿支皮瓣再造乳房的临床效果，从而说明胸廓内动脉远心端供血的可靠性。方法 应用游离的双侧腹壁下动静脉为蒂的腹壁下动脉穿支皮瓣与胸廓内动、静脉远近心断端分别进行端端吻合再造乳房4例。结果 临床应用4例，皮瓣全部成活，再造乳房的形态较满意。术后随访l0～26个月，无腹部薄弱或腹壁疝等并发症发生。结论 胸廓内动、静脉可提供远近心端两组可靠的受区血管。以双侧腹壁下动、静脉为蒂的横行腹壁下动脉穿支皮瓣，适用于乳腺癌根治术后的乳房再造，特别适用于有纵形剖腹产瘢痕及腹壁较薄者的整形修复。     

腹壁下动脉穿支游离皮瓣乳房重建13例分析

我科自2006年3月至2009年3月间共行13例乳腺癌改良根治术后自体皮瓣(DIEP皮瓣)移植重建乳房术,取得良好效果。现报告如下。1临床资料本组13例,年龄30～43岁。肿瘤位于左侧8例,右侧5     

大鼠穿支蒂皮瓣的实验研究

目的建立穿支血管蒂皮瓣的动物实验模型，探讨蒂部穿支血管对皮瓣血供的影响。方法选择30只雄雌不限SD大鼠，分成1个实验组和2个对照组，每组10只，实验组为穿支血管蒂皮瓣组，对照1组为皮下蒂皮瓣组，对照2组为随意皮肤蒂皮瓣组，实验组进行血管造影及组织学检查。结果大鼠腹部皮肤穿支血管起源于腹壁上动脉深支，于腹直肌鞘两侧穿出，共8～10支，穿支垂直间距0．4-1．0cm，以左上第2穿支外径粗大，一条肌皮穿支血管可供养大鼠腹部皮肤81．5％。结论穿支血管蒂皮瓣血供来源于穿支血管，切取穿支血管蒂皮瓣面积比随意皮肤蒂皮瓣面积大，并可提供多种皮瓣设计的选择。     

Contralateral unaffected breast augmentation using zone IV as a SIEA flap during unilateral DIEP flap breast reconstruction

BackgroundContralateral breast augmentation during unilateral breast reconstruction is a good option for women with small breasts. In patients with adequate lower abdominal tissues, the deep inferior epigastric perforator (DIEP) flap is often the first choice for unilateral autologous breast reconstruction. We use Zone IV, which is usually excised owing to its insufficient blood circulation, as a superficial inferior epigastric artery (SIEA) flap for contralateral breast augmentation.MethodsBetween October 2004 and January 2016, 32 patients underwent unilateral breast reconstruction using a DIEP flap and an attempted simultaneous contralateral breast augmentation with an SIEA flap. The unilateral DIEP flap attached to the contralateral SIEA flap was split into two separate flaps after indocyanine green angiography. In all patients, ipsilateral internal mammary vessels were used as recipient vessels for DIEP flap breast reconstruction. The SIEA flap pedicle was anastomosed to several branches of the deep inferior epigastric vessels. The SIEA flap was inset beneath the contralateral breast through the midline.ResultsOf 32 patients, 27 underwent DIEP flap breast reconstruction and simultaneous unaffected breast augmentation using 25 SIEA or 2 superficial circumflex iliac artery perforator (SCIP) flaps. All DIEP flaps survived, and total necrosis occurred in one SIEA flap. The mean weight of the final inset for DIEP flap reconstruction and SIEA or SCIP flap augmentation was 416 g and 112 g, respectively.ConclusionsUnilateral DIEP flap breast reconstruction and contralateral SIEA flap breast augmentation may be safely performed with satisfactory results.     

Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps

ObjectivesThe transverse rectus abdominis musculocutaneous (TRAM) flap is an important option for breast reconstruction. Several studies have recently evaluated whether a greater number of complications result from the use of pedicled TRAM (pTRAM) flaps versus either free TRAM (fTRAM) flaps or deep inferior epigastric artery perforator (DIEP) flaps. To clarify the evidence regarding this issue, we performed an objective meta-analysis of published studies.Materials and methodsA literature search of articles published between January 1, 1990, to January 1, 2017 was performed using the PubMed, EMBASE, Scopus, and Cochrane databases. Heterogeneity was statistically analyzed, and fixed effects and random effects models were used as appropriate.ResultsEleven articles comparing pedicled TRAM (pTRAM) flaps with either free TRAM (fTRAM) or DIEP flaps were included. The articles evaluated a total of 3968 flaps, including 1891 pTRAM flaps, 866 fTRAM flaps, and 1211 DIEP flaps. Patients with fTRAM flaps had a significantly lower risk of fat necrosis and partial flap necrosis than those with pTRAM flaps. No difference was observed in total flap necrosis and hernia or bulge between fTRAM and pTRAM flaps. No difference was noted in flap complications between DIEP and pTRAM flaps except for hernia or bulge..ConclusionAlthough pTRAM flaps are being replaced by fTRAM and DIEP flaps, which exhibit fewer complications related to flap ischemia and donor site morbidity, it was unclear from the literature which flap type was most beneficial regarding flap vascularity and donor site morbidity. Hence, surgeons should choose the appropriate option based on their preferences and on patient factors..