胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣在乳腺肿瘤切除术后胸壁缺损中的应用

目的探讨对侧胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣修复乳腺肿瘤切除术后胸壁软组织缺损的临床效果。方法回顾性分析大连医科大学附属第一医院2018年1月至2019年5月收治的6例乳腺肿瘤患者的临床资料,均为女性,年龄46~73岁,平均55.5岁,其中5例为局部晚期乳腺癌,1例为晚期乳腺癌。病程4个月至5年,中位时间20.1个月。4例患者行术前化疗。术中切除原发病灶后,局部皮肤软组织缺损范围达10 cm×15 cm^21 cm×31 cm,单独采取对侧胸廓内动脉穿支皮瓣或联合带蒂背阔肌Kiss皮瓣修复胸壁缺损,供区直接拉拢缝合,1例患者对侧乳房体积较大,同期行乳房缩小和乳房成形术。术后进行随访,观察皮瓣情况,以及肿瘤是否复发。结果6例胸廓内动脉穿支皮瓣切取范围为5 cm×12 cm^10 cm×23 cm,其中3例联合带蒂背阔肌Kiss皮瓣进行修复,两叶皮瓣每叶面积范围为5 cm×15 cm^7 cm×18 cm,6例患者皮瓣均成活,其中5例创面一期愈合,1例背部供区因张力稍大,出现皮下积液,经换药、引流后切口延期愈合。术后随访1~17个月,平均7.5个月,术区皮肤平整,皮瓣外观良好,对肩关节及腰部活动无影响,肿瘤均无局部复发,供区仅遗留线状瘢痕。结论应用对侧胸廓内动脉穿支皮瓣及背阔肌Kiss皮瓣修复乳腺肿瘤切除后巨大胸壁软组织缺损,无需血管吻合,手术简单,术后恢复快,并发症少,效果较好。

Application of internal thoracic artery perforator propeller flap combines with latissimus dorsi kiss flap to repair skin defects after breast wall tumor resection

Objective To investigate the clinical value of internal thoracic artery perforator propeller flap combines with latissimus dorsi kiss flap in repairing large skin defect of chest wall after breast tumor operation.Methods A retrospective analysis was made on the clinical data from 6 cases of breast tumors admitted to the First Affiliated Hospital of Dalian Medical University between January 2018 and May 2019.There were 6 females with an average age of 55.5 years(range,46-73 years);five of them were all locally advanced breast cancer,one of them was advanced breast cancer.The median disease duration is 20.1 months(range,4 months to 5 years).Four of them accepted chemotherapy before surgery.The area of skin defect ranged from 10 cm×15 cm to 21 cm×31 cm after their primary tumor resection;the internal thoracic artery perforator propeller flap were designed to repair wounds primarily or combined with pedicled latissimus dorsi kiss flap.One of the patients had a large contralateral breast and underwent breast reduction and reconstruction simultaneously.Postoperative follow-up was conducted to observe the flap status and tumor recurrence.Results In the six cases,the size of internal thoracic artery perforator propeller flap was 5 cm×12 cm to 10 cm×23 cm.Three cases combined with kiss flap,with a size of 5 cm×15 cm to 7 cm×18 cm for each lobe.The flap of six patients survived successfully.Five flaps survived with primary healing of wound;one patient suffered from subcutaneous effusion due to a slightly larger tension in the donor area of the back,and delayed wound healing after dressing change and drainage.The follow-up time was from 1 to 17 months(mean,7.5 months)after surgery.The flap had good appearance.The shoulder joint and lumbar activities were normal.No local recurrence occurred and no obvious scar were found at donor sites.Conclusions The application of internal thoracic artery perforator propeller flap and its combined flap in repairing chest wall huge skin defects after breast tumor resection has great clinical value,because no need of vessel anastomosis.It is simple,reliable and rapid postoperative recovery with few complication,and can achieve satisfactory result.