Objective: To explore the effects of pedicled rectus abdominis myocutaneous (PRAM)flap combined with free deep inferior epigastric artery perforator (DIEAP) flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy. Methods: From October 2014 to September 2016, 9 patients with upper limb lymphedema after mastectomy were treated with PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap for breast reconstruction and upper limb lymphedema treatment in Hunan Province Cancer Hospital. The patients were all females, aged 34-66 (44±7) years. The location of deep inferior epigastric artery perforator was detected by audible Doppler ultrasound blood stream detector and computed tomography angiography for designing combined tissue flap, with length of (25.32±0.27) cm, width of (13.14±0.76) cm, and thickness of (3.55±0.34) cm. The donor site of combined tissue flap was closed by suturing, and two or more tubes for negative pressure drainage were placed according to the situation of donor site and recipient site. Operation time and average placing time of negative pressure drainage tube, postoperative condition of combined tissue flap and the donor site, reconstructed breast condition, recovery of upper limb lymphedema were documented and followed up. Results: The operation time was 290-420 (396±55) min. The average retaining time of negative pressure drainage tube in breast was 5.9 d, while the average retaining time of negative pressure drainage tube in abdomen was 4.3 d. Ecchymoma occurred in DIEAP flap of one patient and in the flap donor site of another patient. Delayed healing was also seen in the rectus abdominis myocutaneous flap of a patient, which healed eventually after dressing change, and the other flaps survived well. The appearance of reconstructed breast was good with good elasticity, and no contracture or deformation occurred in the tissue flap. The upper limb lymphedema in 7 patients was alleviated in varying degrees, with 2.0-4.0 cm reduction in circumference. During follow-up of 12-24 months of 9 patients, averaged 17.5 months, with 6 patients received long term bandage pressure therapy and physical therapy to the affected limbs after operation and all patients were satisfied with appearances of the affected limbs. Neuropathic pain in affected limbs was significantly relieved in 2 patients and stopped aggravating in the other 2 patients. Only linear scar was seen in the donor site of abdomen without affecting obviously the function of abdomen. Conclusions: The PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap is an effective way for breast reconstruction and upper limb lymphedema treatment post mastectomy.
目的： 探讨带蒂腹直肌肌皮瓣联合游离腹壁下动脉穿支皮瓣同时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。 方法： 2014年10月—2016年9月，湖南省肿瘤医院采用带蒂腹直肌肌皮瓣联合游离腹壁下动脉穿支皮瓣同时携带髂腹股沟淋巴组织瓣移植对9例乳腺癌术后患者行乳房再造及上肢淋巴水肿治疗。患者均为女性，年龄34～66(44±7)岁。术前用可听式多普勒超声血流探测仪和CT血管造影确定下腹部腹壁下动脉穿支位置，设计联合组织瓣。联合组织瓣长(25.32±0.27)cm、宽(13.14±0.76)cm、厚(3.55±0.34)cm。供瓣区直接拉拢缝合，根据供受区情况留置2根或多根负压引流管。记录患者手术时间、负压引流管平均留置时间，观察组织瓣以及其供区术后情况、再造乳房情况、上肢淋巴水肿恢复情况以及其随访情况。 结果： 本组患者手术时间为290～420(396±55)min。术后胸部负压引流管平均留置5.9 d，腹部负压引流管平均留置4.3 d。1例患者腹壁下动脉穿支皮瓣发生皮下血肿；1例患者腹壁下动脉穿支皮瓣供区发生皮下血肿；1例患者腹直肌肌皮瓣发生延迟愈合，经换药后愈合；其余组织瓣均顺利成活。再造乳房外形可、弹性好，无组织瓣挛缩变形。7例患者上肢淋巴水肿得到不同程度缓解，周径缩小2.0～4.0 cm。9例患者均获随访，时间12～24个月，平均17.5个月，其中6例患者患肢术后长期行绷带加压治疗和物理治疗，所有患者对患肢外形较满意；2例患者的患肢神经痛表现得到缓解，另2例患者患肢神经痛未加重。腹部供区仅遗留线性瘢痕，腹部功能无明显受限，未见其他并发症。 结论： 带蒂腹直肌肌皮瓣联合游离腹壁下动脉穿支皮瓣同时携带髂腹股沟淋巴组织瓣移植是乳腺癌术后乳房再造合并上肢淋巴水肿治疗的有效方法。.
Keywords: Breast neoplasms; Breast reconstruction; Combined tissue flaps; Lymphedema; Surgical flaps.