腹壁上动脉穿支筋膜皮瓣修复乳腺恶性肿瘤术后胸壁巨大创面的临床效果

袁莹; 周敏; 漆白文; 喻爱喜; 简超; 吴亦凡

doi:10.3760/cma.j.cn501225-20240930-00367

腹壁上动脉穿支筋膜皮瓣修复乳腺恶性肿瘤术后胸壁巨大创面的临床效果

doi: 10.3760/cma.j.cn501225-20240930-00367

武汉大学中南医院创伤与显微骨科,武汉　　430071

基金项目:

湖北省揭榜制科技项目 2022BEC028

详细信息

通讯作者:
吴亦凡,Email：2013302180035@whu.edu.cn

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出版历程
- 收稿日期: 2024-09-30

Clinical effects of superior epigastric artery perforator fascial flaps in repairing huge chest wall wounds after breast tumor surgery

Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China

Funds:

Science and Technology Department of Hubei Province Jiebang Project 2022BEC028

More Information

Corresponding author: Wu Yifan, Email: 2013302180035@whu.edu.cn

摘要

摘要: 目的探讨采用腹壁上动脉穿支筋膜皮瓣修复乳腺恶性肿瘤术后胸壁巨大创面的临床效果。方法该研究为回顾性观察性研究。2018年7月—2024年6月,武汉大学中南医院收治8例乳腺恶性肿瘤患者,肿瘤扩大切除术后造成的胸壁皮肤软组织缺损面积达20 cm×18 cm~24 cm×20 cm,均采用腹壁上动脉穿支筋膜皮瓣修复。于胸壁缺损同侧沿腹直肌表面切取皮瓣,皮瓣切取面积为20 cm×8 cm~18 cm×10 cm。皮瓣远端保留腹壁下血管及其粗大穿支,将4例患者皮瓣远端腹壁下血管与受区胸廓内血管穿支吻合,4例患者未行血管吻合。将所有患者供区创面直接缝合。术后观察皮瓣成活情况、供受区创面愈合情况及并发症发生情况。术后随访时,观察胸部肿瘤复发情况、皮瓣外形及供区并发症发生情况。结果所有患者术后皮瓣成活,未发生血管危象。2例患者术后皮瓣远端出现散在淤斑,经对症支持治疗后未进展为皮瓣坏死,且淤斑均于术后4周内消退。所有供受区创面均愈合,无并发症发生。随访3~6个月,肿瘤局部无复发；皮瓣外形良好；供区遗留轻度线性瘢痕增生,无腹壁疝、腹壁薄弱表现。结论腹壁上动脉穿支筋膜皮瓣切取操作简单,皮瓣成活率高,供区损伤较小,能有效修复乳腺恶性肿瘤术后胸壁巨大皮肤软组织缺损创面。
- 显微外科手术 /
- 乳腺肿瘤 /
- 胸壁 /
- 穿支皮瓣 /
- 筋膜皮瓣 /
- 腹壁上动脉穿支 /
- 创面修复
Abstract: Objective To investigate the clinical effects of superior epigastric artery perforator fascial flaps in repairing huge chest wall wounds after breast tumor surgery. Methods This study was a retrospective observational research. From July 2018 to June 2024, 8 patients with breast tumor were admitted to Zhongnan Hospital of Wuhan University. The areas of skin and soft tissue defects of chest wall caused by extended resection of tumor reached 20 cm×18 cm to 24 cm×20 cm, and all of them were repaired by superior epigastric artery perforator fascial flaps. The flaps were excised along the surface of the rectus abrectus muscle on the same side of the chest wall defects, with the harvested flap area of 20 cm×8 cm to 18 cm×10 cm. The inferior abdominal vessels and their large perforators were retained at the distal end of the flaps. The inferior abdominal wall vessels at the distal end of the flaps were anastomosed with the internal thoracic vascular branches in the recipient areas in 4 patients, while no vessels were anastomosed in the other 4 patients. The wounds in the donor areas were sutured directly in all patients. The survival of the flaps, and the healing of the wounds and the occurrence of complications in the donor and recipient areas were observed after the operation. Postoperative follow-up was conducted to observe the thoracic tumor recurrence, the flap appearance, and the occurrence of complications in the donor area. Results The flaps in all patients survived well, without occurrence of vascular crisis. The scattered ecchymosis appeared at the distal end of the flaps in two patients after surgery, which did not progress to flap necrosis after symptomatic and supportive treatment, and the ecchymosis subsided within 4 weeks after surgery. All the wounds in the donor and recipient areas healed without complications. The follow-up for 3 to 6 months showed no local recurrence of the tumor, satisfactory appearance of the flap, mild linear scar hyperplasia left in the donor area, and no abdominal hernia or abdominal wall weakness. Conclusions The superior abdominal artery perforator fascial flap is simple in resection operation, has a high survival rate, causes less damage to the donor area, and can effectively repair the huge skin and soft tissue defect wounds of the chest wall after operation of breast tumor.
- Microsurgery /
- Breast neoplasms /
- Thoracic wall /
- Perforator flap /
- Fascial flap /
- Superior epigastric artery perforator /
- Wound repair
袁莹：研究设计、研究方案的实施、数据采集、论文撰写；周敏、漆白文：数据整理、资料收集、治疗随访；喻爱喜：论文修改、资金支持；简超：研究方案制订与指导、实施手术；吴亦凡：研究方案制订与指导、实施手术、论文修改

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参考文献(40)

[1]	于峻懿,宋达疆,李赞,等.双侧游离股前外侧肌皮瓣联合移植修复巨大胸壁缺损[J].中国临床解剖学杂志,2024,42(5):555-559.DOI: 10.13418/j.issn.1001-165x.2024.5.11.
[2]	DaiZ,MaihemutiM,SunY,et al.Resection and reconstruction of huge tumors in the chest wall[J].J Cardiothorac Surg,2022,17(1):116.DOI: 10.1186/s13019-022-01877-9.
[3]	刘春军,栾杰.腹部皮瓣:乳腺癌术后乳房再造的金标准[J]. 中华整形外科杂志,2021,37(7):709-711. DOI: 10.3760/cma.j.cn114453-20210708-00291.
[4]	SethAK,AllenRJ.Modern techniques and alternative flaps in microsurgical breast reconstruction[J].J Surg Oncol,2018,118(5):768-779.DOI: 10.1002/jso.25198.
[5]	GrottingJC,UristMM,MaddoxWA,et al.Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction[J].Plast Reconstr Surg,1989,83(5):828-841; discussion 842-844.DOI: 10.1097/00006534-198905000-00009.
[6]	TachiM,YamadaA.Choice of flaps for breast reconstruction[J].Int J Clin Oncol,2005,10(5):289-297.DOI: 10.1007/s10147-005-0527-4.
[7]	PatelNG,RamakrishnanV.Microsurgical tissue transfer in breast reconstruction[J].Clin Plast Surg,2020,47(4):595-609.DOI: 10.1016/j.cps.2020.06.010.
[8]	于峻懿,宋达疆,刘旭,等. 组合组织瓣移植修复巨大胸壁缺损的临床效果[J]. 中华烧伤与创面修复杂志,2024,40(7):650-656. DOI: 10.3760/cma.j.cn501225-20231120-00199.
[9]	CorkumJP,GarveyPB,BaumannDP,et al.Reconstruction of massive chest wall defects: a 20-year experience[J].J Plast Reconstr Aesthet Surg,2020,73(6):1091-1098.DOI: 10.1016/j.bjps.2020.02.010.
[10]	汪时劲,李思言,毛晓韵.乳腺巨大浸润性乳头状癌无转移1例[J].中国临床案例成果数据库,2024,6(1):E0288-E0288.DOI: 10.3760/cma.j.cmcr20230929-02200.
[11]	彭睿,章伟文,王晓峰,等.三维重建术前优化设计腹前外侧跨区游离穿支皮瓣修复四肢软组织缺损[J].中华显微外科杂志,2023,46(3):291-296.DOI: 10.3760/cma.j.cn441206-20221107-00228.
[12]	AlsharkawyK,YoussifS,MalahiasM,et al.Acromiothoracic venous supercharge for abdominal-based free flaps in breast and chest wall reconstruction[J].Ann Plast Surg,2023,91(6):734-739.DOI: 10.1097/SAP.0000000000003704.
[13]	BeugelsJ,LevineJL,VasileJV,et al.The delay procedure in deep inferior epigastric artery perforator flap breast reconstruction[J].Plast Reconstr Surg,2024,153(6):1063e-1072e.DOI: 10.1097/PRS.0000000000010837.
[14]	李涛,陈振兵,陈燕花,等.以腹壁下动脉穿支为蒂的血流桥接皮瓣修复肢体创面缺损[J].中华整形外科杂志,2014,30(5):339-343.DOI: 10.3760/cma.j.issn.1009-4598.2014.05.005.
[15]	SmithML,GandolfiBM,DayanE,et al.Bilateral breast reconstruction from a single hemiabdomen using angiosome-based flap design[J].Plast Reconstr Surg,2013,132(2):291-294.DOI: 10.1097/PRS.0b013e31829587ca.
[16]	WallaceCG,KaoHK,JengSF,et al.Free-style flaps: a further step forward for perforator flap surgery[J].Plast Reconstr Surg,2009,124(6Suppl):e419-e426.DOI: 10.1097/PRS.0b013e3181bcf189.
[17]	WeiFC,MardiniS.Free-style free flaps[J].Plast Reconstr Surg,2004,114(4):910-916.DOI: 10.1097/01.prs.0000133171.65075.81.
[18]	MountziarisPM,PatelA,RezakKM.Breast reconstruction with superior epigastric artery perforator (SEAP) free flap: report of two cases[J].Microsurgery,2020,40(5):593-597.DOI: 10.1002/micr.30563.
[19]	HamdiM,Van LanduytK,UlensS,et al.Clinical applications of the superior epigastric artery perforator (SEAP) flap: anatomical studies and preoperative perforator mapping with multidetector CT[J].J Plast Reconstr Aesthet Surg,2009,62(9):1127-1134.DOI: 10.1016/j.bjps.2007.12.078.
[20]	WongC,Saint-CyrM,RaskoY,et al.Three- and four-dimensional arterial and venous perforasomes of the internal mammary artery perforator flap[J].Plast Reconstr Surg,2009,124(6):1759-1769.DOI: 10.1097/PRS.0b013e3181bf815f.
[21]	武雷,丁英状,郝敏如,等. 两种下腹部组织瓣修复四肢大面积皮肤软组织缺损后患者的腹部功能与外形[J]. 中华烧伤与创面修复杂志,2023,39(10):959-967. DOI: 10.3760/cma.j.cn501225-20230428-00145.
[22]	王志永,马菊英,韩峰梅,等. 应用L形腹直肌肌皮瓣再造乳房六例[J]. 中华烧伤杂志,2012,28(4):272-273. DOI: 10.3760/cma.j.issn.1009-2587.2012.04.014.
[23]	关山.乳腺癌术后乳房重建的意义及常用方法[J].中国医刊,2024,59(5):475-477.DOI: 10.3969/j.issn.1008-1070.2024.05.003.
[24]	TakedaS,MitsuyaS,YamamotoM,et al.Advantages of the external fixator for stabilizing pedicled abdominal or groin flap[J].J Plast Reconstr Aesthet Surg,2020,73(4):783-808.DOI: 10.1016/j.bjps.2019.11.058.
[25]	HartrampfCR,ScheflanM,BlackPW.Breast reconstruction with a transverse abdominal island flap[J].Plast Reconstr Surg,1982,69(2):216-225.DOI: 10.1097/00006534-198202000-00006.
[26]	KhoongYM,HuangX,GuS,et al.Imaging for thinned perforator flap harvest: current status and future perspectives[J/OL].Burns Trauma,2021,9:tkab042[2024-09-30].https://pubmed.ncbi.nlm.nih.gov/34926708/. DOI: 10.1093/burnst/tkab042.
[27]	黄胜超,邱璞,梁忠锃,等. 带蒂横向腹直肌肌皮瓣在乳腺癌术后即刻重建乳房中的应用[J]. 中华内分泌外科杂志,2021,15(2):117-121. DOI: 10.3760/cma.j.cn.115807-20201208-00382.
[28]	梁馨予,魏余贤,魏庭庭,等.乳腺癌术后即刻背阔肌皮瓣联合假体植入与带蒂腹直肌皮瓣乳房重建的疗效比较[J].中华内分泌外科杂志,2024,18(2):178-183.DOI: 10.3760/cma.j.cn.115807-20231211-00186.
[29]	卢璐,刘家祺,朱明,等.V-Y推进式背阔肌肌皮瓣在胸壁缺损创面修复重建中的临床应用[J].中华整形外科杂志,2022,38(2):138-142.DOI: 10.3760/cma.j.cn114453-20200319-00167.
[30]	刘美亚,陈永静,马骏杰,等.不同方法切取分叶背阔肌皮瓣在局部晚期乳腺癌术后胸壁缺损修复中的应用价值(附视频)[J].中华内分泌外科杂志,2023,17(5):550-553.DOI: 10.3760/cma.j.cn.115807-20220926-00260.
[31]	宋达疆,李赞,章一新,等.带蒂腹直肌肌皮瓣联合游离腹壁下动脉穿支皮瓣及携带髂腹股沟淋巴组织瓣行乳腺癌根治术后乳房再造及上肢淋巴水肿治疗的效果[J].中华烧伤杂志,2020,36(4):297-303.DOI: 10.3760/cma.j.cn501120-20190117-00011.
[32]	OuyangY,XuB,LuanJ,et al.Chest wall reconstruction in male Poland syndrome patients with endoscopic-assisted latissimus dorsi muscle flap transfer[J].J Plast Reconstr Aesthet Surg,2021,74(11):3141-3149.DOI: 10.1016/j.bjps.2021.03.117.
[33]	OdaG,NakagawaT,UemuraN,et al.Axillary lymph node recurrence in patients with breast cancer who underwent breast reconstruction using a latissimus dorsi flap after mastectomy[J].Mol Clin Oncol,2021,14(3):49.DOI: 10.3892/mco.2021.2211.
[34]	ZahiriHR,LumpkinsK,KelishadiS,et al.Pectoralis major turnover versus advancement technique for sternal wound reconstruction[J].Ann Plast Surg,2013,70(2):211-215.DOI: 10.1097/SAP.0b013e3182367dc5.
[35]	HerlinC,BertheuilN,BekaraF,et al.Leech therapy in flap salvage: systematic review and practical recommendations[J].Ann Chir Plast Esthet,2017,62(2):e1-e13.DOI: 10.1016/j.anplas.2016.06.004.
[36]	LiL,YangY,LiW,et al.Latissimus dorsi myocutaneous flap repair is effective after neoadjuvant chemotherapy for locally advanced breast cancer[J].World J Surg Oncol,2022,20(1):134.DOI: 10.1186/s12957-022-02598-y.
[37]	任杰,汪阳,席儒兴. 顺行法分叶背阔肌皮瓣在LABC切除术后胸壁修复重建中的应用[J]. 国际医药卫生导报,2025,31(12):2056-2061. DOI: 10.3760/cma.j.cn441417-20240827-12025.
[38]	吴祥虎,陈春龙,丁皓,等.乳腺癌超象限切除术联合背阔肌皮瓣转移乳房重建术对乳腺癌患者美容效果和预后的影响[J].黑龙江医学,2023,47(12):1416-1420.DOI: 10.3969/j.issn.1004-5775.2023.12.002.
[39]	张辉,张颖,华江伟,等. 不同部位皮瓣移植对乳腺癌保乳术患者肿瘤学安全性及乳房缺损修复效果的影响[J]. 中国性科学,2022,31(7):95-98. DOI: 10.3969/j.issn.1672-1993.2022.07.025.
[40]	董苑,李姝墨,陈亮,等.V-Y背阔肌肌皮瓣修复局部晚期乳腺癌术后胸壁缺损14例[J].中华显微外科杂志,2022,45(6):634-638.DOI: 10.3760/cma.j.cn441206-20220612-00116.

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图 1 采用腹壁上动脉穿支筋膜皮瓣修复患者胸壁创面的效果。1A.术前右侧胸壁肿瘤；1B.肿瘤切除后见右侧胸壁皮肤软组织缺损伴右侧肋弓骨外露；1C.减张缝合缩小胸壁创面后；1D.腹壁上动脉穿支筋膜皮瓣切取完成；1E.皮瓣转位覆盖右侧胸壁创面后外观；1F.术后1个月随访时,创面愈合良好,皮瓣外形良好,供受区无明显并发症

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