Objective: To summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.
Methods: The clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.
Results: All DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found.
Conclusion: It is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.
目的: 总结游离腹壁下动脉穿支皮瓣（deep inferior epigastric artery perforator flap，DIEP）移植在纵形瘢痕乳腺癌二期再造中乳房塑形的难点和要点。.
方法: 回顾分析 2015 年 10 月—2019 年 10 月收治的 32 例二期行游离 DIEP 移植再造乳房的乳腺癌术后患者，原手术切口均为垂直纵形。患者均为女性；年龄 31～42 岁，平均 34.6 岁。乳腺癌病程 9～48 个月，平均 22.8 个月。均采用对侧血管蒂的游离 DIEP 移植，受区血管为胸廓内血管。其中 17 例皮瓣为纵形摆放，15 例皮瓣为斜形摆放；18 例采用辅助“Z”字皮瓣调整受区胸壁皮袋；23 例同时行对侧乳房缩乳上提术。.
结果: 所有 DIEP 完全成活，供、受区创面均Ⅰ期愈合。1 例病理检查发现内乳淋巴结转移，术后行放疗。32 例均获随访，随访时间 9～48 个月，平均 19.4 个月。所有皮瓣外观、质地满意，供区仅遗留线性瘢痕。11 例患者术后行自体脂肪移植和乳头重建。所有患者腹壁活动无影响，均未见局部复发和转移。.
结论: 在乳腺癌改良根治术后纵形瘢痕情况下，采用游离 DIEP 移植二期再造乳房难度较大，结合不同的乳房塑形技巧可以明显改善重建效果。.
Keywords: Deep inferior epigastric artery perforator flap; breast cancer; breast reconstruction; flap shaping.