The strategy and technical keypoints of bilateral lower abdominal flaps combined with bilateral free posteromedial thigh flaps transplantation for bilateral breast reconstruction
10.3760/cma.j.cn114453-20240422-00103
- VernacularTitle:双侧下腹部皮瓣联合双侧游离股后内侧皮瓣移植再造双侧乳房的策略和技术要点
- Author:
Dajiang SONG
1
;
Tianyi ZHANG
;
Zhiyuan WANG
;
Xu LIU
;
Zan LI
;
Xiaozhen WANG
Author Information
1. 湖南省肿瘤医院肿瘤整形外科，长沙 410008
- Publication Type:Journal Article
- Keywords:
Breast neoplasms;
Rectus abdominis myocutaneous flap;
Deep inferior epigastric artery perforator flap;
Posteromedial thigh flap;
Breast reconstruction
- From:
Chinese Journal of Plastic Surgery
2024;40(12):1306-1314
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the strategies and technical points of combined bilateral lower abdominal flaps and bilateral free posteromedial thigh flaps transplantation for bilateral breast reconstruction.Methods:A retrospective analysis was conducted on the clinical data of patients who underwent bilateral breast reconstruction using bilateral free lower abdominal flaps combined with bilateral free posteromedial thigh flaps in the Department of Oncology Plastic Surgery at Hunan Cancer Hospital from August 2021 to April 2023. The key points for developing and flexibly adjusting the surgical strategy were based on the anatomic characteristics of blood vessels in recipient area and donor area. Accurate measurement of the volume, shape, and extent of skin defects of the bilateral breast was performed through physical examination and imaging studies to determine the size and shape of the required flaps. The number of perforating vessels and blood supply capacity of the lower abdomen and the posterior internal donor area of both thighs were detected by Doppler or color ultrasound to determine the free/pedicled lower abdomen flap. On this basis, the placement of the posteromedial thigh flaps and the vascular anastomotic position were determined. Postoperative follow-up included monitoring for complications, evaluating the outcomes of breast reconstruction, assessing patient satisfaction, and examining the functional status of both the donor and recipient areas.Results:A total of 9 female patients were included, aged from 27 to 45 years old, with an average age of 37.4 years. Specifically, it included immediate breast reconstruction on 6 sides, immediate delayed breast reconstruction on 5 sides, and delayed breast reconstruction on 7 sides. There were three specific forms of lower abdominal skin flap, including pedicled rectus abdominis skin flap (4 sides), free rectus abdominis skin flap carrying partial rectus abdominis muscle (5 sides), and free inferior abdominal artery perforator skin flap (9 sides). There were four specific forms of free posteromedial thigh flap, including gracilis muscle flap (6 sides), gracilis muscle flap carrying partial gracilis muscle (4 sides), greater adductor muscle perforator flap (3 sides), and greater adductor muscle flap (5 sides). There were four specific skin flap combinations for reconstructing one side of the breast, including a pedicled rectus abdominis skin flap combined with a free lower abdominal skin flap (4 sides), a bilateral free lower abdominal skin flap (3 sides), a bilateral free posteromedial thigh skin flap (7 sides), and a combination of a free lower abdominal skin flap and a free posteromedial thigh skin flap (4 sides). All skin flaps survived smoothly without any significant complications. Follow up for 12-18 months, with an average of 14.7 months. The reconstructed breast had a good appearance, satisfactory texture, and was basically symmetrical. The skin flap donor area and breast recipient area only had linear scars, and there was no significant impact on the function of the thigh and abdominal wall.Conclusion:According to the blood vessels in the donor and recipient areas, the amount of tissue in the donor area, the amount of tissue required for breast reconstruction, and the shape of the breast, the combination of bilateral lower abdominal flaps and bilateral free posteromedial thigh flaps transplantation can reconstruct the symmetrical and beautiful bilateral breast, but the surgical strategy is relatively complicated. Vigorous process management can improve surgical safety and satisfaction.
