扩大背阔肌肌皮瓣乳房再造

目的 介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法。方法 将背阔肌周围脂肪组织分为5个区，在背部设计半月形皮肤切口，切取背阔肌及周围脂肪组织，不应用乳房假体，进行即时或后期乳房再造。结果 应用该方法乳房再造35例，再造乳房形态良好，结论 扩大背阔肌肌皮瓣乳房再造，安全有效，再造乳房形态良好，是乳房再造的重要进展。     

扩大背阔肌肌皮瓣乳房再造

目的　介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法。方法　将背阔肌周围脂肪组织分为 5个区 ,在背部设计半月形皮肤切口 ,切取背阔肌及周围脂肪组织 ,不应用乳房假体 ,进行即时或后期乳房再造。结果　应用该方法乳房再造 35例 ,再造乳房形态良好。结论　扩大背阔肌肌皮瓣乳房再造 ,安全有效 ,再造乳房形态良好 ,是乳房再造的重要进展。     

扩大背阔肌肌皮瓣乳房再造

目的 介绍单纯应用扩大背阔肌肌皮瓣进行乳房再造方法.方法 将背阔肌周围脂肪组织分为5个区,切取背阔肌及周围脂肪组织,不应用乳房假体,进行即时或后期乳房再造.结果 应用该方法再造乳房95例,其中保留乳头乳晕改良根治术后即时再造24例,保留皮肤改良根治术后即时再造36例,改良根治术后即时再造26例,后期再造9例,其中1例为改良根治术后,其他8例为改良根治术后,再造乳房均形态良好.术后6例乳头部分坏死;14例胸部皮肤表皮脱落,自行愈合;2例背部供区部分坏死;背部顽固性血清肿2例,再次手术后愈合.结论 扩大背阔肌肌皮瓣乳房再造安全有效,再造乳房形态良好,尤其适用于中、小乳房的乳房再造.     

改良背阔肌肌皮瓣乳房再造术

目的 探讨背阔肌肌皮瓣在乳房再造术中的的应用价值,为临床自体乳房再造提供一种有效的手术方式。方法 １９９４年以来,采用以背阔肌肌皮瓣及胸背动脉营养的脂肪组织联合移位,以对侧乳房的形态及体积为参照,进行取材及塑形的自体组织再造乳房。结果 ６０例（６０侧）乳房再造手术人武部成功,经过３个月～５年随访,术后效果满意４１例,占６８．３％,比较满意１６例,占２６．７％,不满意３例,占５．０％。结论 改良背阔     

扩大背阔肌肌皮瓣在乳腺癌改良根治术后一期乳房再造中的应用

目的评价扩大背阔肌肌皮瓣在乳腺癌改良根治术后一期乳房再造中的应用价值。方法选取我科2008年1月至2009年6月期间收治的48例乳腺癌患者,根据所接受的术式分为扩大背阔肌肌皮瓣一期乳房再造（乳房再造）组（n=12）和单纯乳腺癌改良根治术（单纯根治）组（n=36）,对2组患者术后并发症、恢复情况以及生活质量进行对比,并对再造乳房外观形态进行评价。结果乳房再造组患者均成功行扩大背阔肌肌皮瓣乳房再造,再造乳房外形评价良好6例,中4例,差2例,明显优于单纯根治组（P〈0.001）。2组患者术后积液、皮瓣坏死、患肢及肩关节活动、住院时间、引流时间及开始辅助治疗时间差异均无统计学意义（P〉0.05）,但乳房再造组术后生活质量较好,与单纯根治组比较差异有统计学意义（P〈0.001）。乳房再造组有10例行术后辅助放化疗,未出现转移皮瓣坏死。2组患者随访2～17个月（中位时间8个月）,未见局部复发及转移。结论乳腺癌根治术后扩大背阔肌肌皮瓣一期再造乳房形态效果良好,手术操作简单,对早期乳腺癌是一种安全、可行的治疗方法 。     

背阔肌肌皮瓣在乳房再造中的应用

目的探讨利用背阔肌肌皮瓣进行乳房再造的设计、手术操作及效果。方法2005年5月至2006年4月行背阔肌肌皮瓣乳房再造18例,其中8例联合假体置入。观察指标包括手术时间、术后并发症及美学效果。结果平均手术时间为147min。再造乳房全部成活,无严重术后并发症。除1例再造乳房位置偏高以外,其余17例（94.4%）患者对再造乳房均很满意。结论背阔肌肌皮瓣或联合假体置入乳房再造操作简便、术后并发症少,再造乳房形态好,是一种可供选择的乳房再造方法。     

扩大背阔肌肌皮瓣乳房再造术后供区并发症的探讨

目的 探讨扩大背阔肌肌皮瓣再造乳房术后供区的并发症及其防治.方法 自1999年5月至2004年11月,为88例患者采用扩大背阔肌肌皮瓣再造乳房后,从主观和客观两方面分析供区并发症的发生原因以及术后功能情况的评估.结果 术后1例血肿,7例血清肿（其中2例有包囊形成）,5例轻度皮缘表皮脱落,1例干性皮肤坏死,2例翼状肩,无感染和瘢痕增生.术后功能无明显受限,不影响日常生活.结论 扩大背阔肌肌皮瓣乳房再造术后并发症主要是血清肿,严重并发症少,并可以防止或减少,患者容易接受,是值得在东方人中推广使用的乳房再造方法.     

扩大背阔肌皮瓣乳房再造术的护理

乳房是女性显示性征和体态健美的重要标记。乳房的缺失可使人压抑自卑，甚至产生性障碍。乳房再造能防止或减轻这种消极心理，改善生活质量。作者所在科室自2001年开始应用扩大背阔肌皮瓣移位再造乳房10例，取得了较好的临床效果。现将护理体会总结如下。     

腹直肌-背阔肌肌皮瓣联合应用乳房再造术

目的　探索一种同时修复乳房和胸壁缺损的手术方法。方法　利用下腹部横行腹直肌肌皮瓣 (下简称TRAM皮瓣 )和部分背阔肌肌皮瓣 ,为乳癌术后患者行乳房再造及胸壁缺损修复。结果　 4例 8个皮瓣全部成活 ,再造乳房及胸壁缺损修复效果满意。结论　联合应用腹直肌—背阔肌肌皮瓣 ,可以同时完成乳房再造及胸壁缺损的修复 ,效果满意。     

乳腺癌根治术后即刻行扩大背阔肌肌皮瓣乳房再造50例分析

目的探讨保留乳头、乳晕的乳腺癌改良根治术后即刻行扩大背阔肌肌皮瓣乳房再造的治疗及美容效果。方法收集2014年4月至2019年4月收治的50例乳腺癌患者临床资料,所有患者均采用保留乳头、乳晕(NSM)或保留皮肤(SSM)的乳腺癌改良根治术联合扩大背阔肌肌皮瓣乳房再造,观察手术相关指标(手术时间、手术出血量及引流管留置时间)及术后并发症情况,并评价术后美容效果。结果50例患者均成功完成保留乳头、乳晕或保留皮肤的乳腺癌改良根治术后即刻乳房再造术,皮瓣存活率100%,乳腺组织切除量(200±50)g,手术时间(220±40)min,手术出血量(35±15)mL,胸部引流管留置(12±4)d,背部引流管留置(20±5)d。其中,2例患者术后1个月存在背部血清肿,经重新置管引流后消除;1例患者术后出现乳头部分缺血坏死,经换药后愈合;1例患者术后出现上肢活动受限,经功能锻炼后缓解。美容效果评价显示,再造乳房优良率92%。所有患者随访36~60个月(中位数48个月),均未见局部复发及远处转移。结论乳腺癌改良根治术后即刻行扩大背阔肌肌皮瓣乳房再造术适合亚洲女性的中、小型乳房,手术可操作性强,美容效果好,值得临床推广。     

Postmastectomy reconstruction with extended latissimus dorsi myocutaneous flap for Hong Kong Chinese

Objective: Because of the smaller breast size of Chinese women, postmastectomy reconstruction without prosthesis by extended latissimus dorsi (LD) flap is potentially more applicable in the Chinese population. Methods: Patients who had undergone immediate postmastectomy breast reconstruction by extended latissimus dorsi flap without prosthesis were retrospectively studied. Surgical complications, aesthetic result and patient satisfaction were evaluated. Results: Ten Asian patients (nine Chinese and one Filipino) underwent extended LD flap for breast reconstruction after mastectomy. There was no total or partial flap failure. Operative complications included seroma in one patient and minor wound edge slough at back wounds in two patients. Simultaneous seroma and minor donor wound slough occurred in another patient. Aesthetic outcome was excellent (n = 5), good (n = 4) and poor (n = 1). Patient satisfaction with the procedure was very satisfied in four, satisfied in four and dissatisfied in two, respectively. All but two patients would recommend the same procedure to their friends or relatives. Conclusion: Extended LD flap can reliably achieve pleasing results with low morbidity. It has more potential to become a competitive alternative to transverse abdominis myocutaneous flap in most Chinese women for postmastectomy reconstruction.     

Intraoral reconstruction with latissimus dorsi myocutaneous island flap

Summary Intraoral reconstruction for large defects using a latissimus dorsi myocutaneous island flap in ten patients is presented. All flaps were transferred successfully in one stage and provided adequate flap tissue for the intraoral defect. Five cases involved hemiglossectomy. The postoperative atrophy of the flap was minor and the intraoral defects were adequately resurfaced. The postoperative function of the remaining tongue was satisfactory. The latissimus dorsai myocutaneous flap was found to be reliable and useful for intraoral reconstruction.     

可扩张乳房假体加背阔肌肌皮瓣的乳房再造术

目的：报告应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体（BECKER）置入,修复乳腺癌根治术后的胸壁畸形,同时再造乳房的手术方法。方法：根据乳腺癌病灶清除术后患者胸部的畸形状况,设计患侧带蒂背阔肌肌皮瓣的肌瓣长度、体积以及皮瓣的面积和形状,切取肌皮瓣后经腋部皮下隧道转移至胸前。用肌瓣修复胸前软组织缺损,皮瓣则用于弥补胸部皮肤的不足。肌瓣与胸壁间置入可扩张的乳房假体。术后经注射壶注水,逐步扩张至额定值。6个月后,可抽除注射壶并重建乳头,完成治疗。结果：自1999年以来,对各种乳腺癌术后患者行乳房再造术共26例,获得了满意效果。结论：应用带蒂背阔肌肌皮瓣转移术及可扩张的乳房假体置入,不仅可修复乳腺癌病灶清除术后的胸部软组织的缺损、锁骨下的凹陷畸形而且可重建乳房。该法具有创伤小、恢复快、再造乳房的外形及质感逼真等特点。     

Entire pharyngoesophageal reconstruction with latissimus dorsi myocutaneous island flap

The entire pharynx and cervical esophagus were reconstructed after total laryngectomy and pharyngoesophagectomy for advanced cancer in 14 patients with the use of a pedicled latissimus dorsi myocutaneous island flap. All flaps were transferred successfully in one stage. The reliability of the flap and postoperative state of food passage were studied. Repair was confirmed by roentgenographic examination 6 months after surgery. A slight narrowness was noted at the portion anastomosed with the esophagus, with dilatation of the reconstructed segment. All patients in our study have been able to resume normal oral feeding. The pedicled latissimus dorsi myocutaneous island flap is reliable and useful for the reconstruction of the pharynx and cervical esophagus.     

Oblique latissimus dorsi myocutaneous flap in breast reconstruction

Breast reconstruction with latissimus dorsi myocutaneous flap is a reliable technique. Its width is limited to between 10 and 12 cm if direct closure of the donor site defect is required. We report a study with assessment of the dorsal skin laxity in 25 women, simulating vertical, horizontal and reverse oblique flap. The average width was 12.5 cm (11.6 to 14 cm) for reverse oblique flap, 9.4 cm (8 to 11 cm) for vertical and 9.2 cm (8 to 10.6 cm) for horizontal flap. Our study suggests that the reverse-oblique flap provides a wider flap and reduces the donor site morbidity.     

Improvement of upper extremity lymphedema after delayed breast reconstruction with an extended latissimus dorsi myocutaneous flap

Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.     

背阔肌肌皮瓣乳房重建的治疗现状与进展

乳房是女性重要的第二性征器官,承负着哺乳的重要功能,是女性曲线美的重要外在表现,也是女性自信心的来源。随着社会的发展,医疗水平的提高,女性乳腺癌的确诊率及治愈率均呈上升趋势,早期乳腺癌的治疗逐步向以保乳手术为主的综合治疗发展。