Causes of blood supply disorder in large complex defects after repair of chest wall tumours with pedicled rectus abdominis flap
10.3760/cma.j.issn.1671-0290.2024.05.001
- VernacularTitle:带蒂腹直肌皮瓣修复胸壁肿瘤术后大面积复杂缺损血运障碍的原因分析
- Author:
Tianyi ZHANG
1
;
Dajiang SONG
;
Zan LI
;
Jingjun ZHU
Author Information
1. 哈尔滨医科大学附属第一医院乳腺外科，哈尔滨 150001
- Keywords:
Breast neoplasms;
Pedicled rectus abdominis flap;
Free deep inferior epigastric artery perforator flap;
Chest wall reconstruction;
Vascular anastomosis
- From:
Chinese Journal of Medical Aesthetics and Cosmetology
2024;30(5):413-418
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the causes of blood supply disorder of the pedicled rectus abdominis flap.Methods:Between January 2019 and May 2021, a cohort of 61 female patients, aged 25 to 70 years with a mean age of (46.9±2.1) years, underwent surgical repair for extensive thoracic wall defects at Hunan Province Cancer Hospital. These defects, resulting from thoracic wall tumor resection, were addressed using a combination of pedicled rectus abdominis myocutaneous flaps and free inferior abdominal artery perforator flaps. The patient cohort included 39 cases of locally advanced breast cancer, 12 cases of recurrent breast cancer, 6 cases of lobular cell sarcoma, and 4 cases of soft tissue sarcoma. The patients were divided into two groups according to the order of revascularization sequence of free inferior abdominal artery perforator flap: 31 cases in the group of anastomosing the artery first and then the accompanying vein (group A), and 30 cases in the group of anastomosing the vein first and then the artery (group B). The main reasons for the blood supply disorders of the pedicled rectus abdominis flap were analysed in the two groups.Results:In all 61 patients, the pedicled rectus abdominis myocutaneous flap showed immediate red and purple plaques and other blood supply disorders. Further anastomosis of the free inferior abdominal wall artery perforating the flap vessel tip was conducted to achieve pressurization. The vascular selection for the recipient area included the intrathoracic vessels in 26 cases, the thoracic acromion vessels in 15 cases, the thoracodorsal vessels in 9 cases, the anterior serratus branch of the thoracodorsal vessels in 7 cases, and the lateral thoracic arteries and veins in 4 cases. The flap length measured (29.1±0.6) cm, while the width of the skin island was (12.9±0.6) cm. The follow-up period was from 9 to 16 months, with a mean of 12.7 months.In the Group A, the flap blood supply was significantly relieved before further anastomosing the vein in 7 cases, and the flap blood supply returned to normal in the other 24 cases after further anastomosing the vein. In the Group B, the flap blood supply was significantly relieved before further anastomosing the artery in 27 cases, and the flap blood supply returned to normal in the other 3 cases after further anastomosing the artery.61 flaps survived completely, the shape of reconstructed chest wall was satisfactory, and there was no flap contracture and deformation; only linear scar was left in the donor area of the flap, and there was no significant effect on the function of the abdominal wall. The patients were followed-up for 9-16 months, with an average of 12.7 months.Conclusions:The main reason for the blood supply obstacle of the rectus abdominis flap is the venous return obstacle, in order to ensure the reliable blood supply of the flap, the venous return should be increased as a priority.
