Experience of bilateral free posteromedial thigh flaps for unilateral breast reconstruction
10.3760/cma.j.cn114453-20220323-00083
- VernacularTitle:双侧游离股后内侧皮瓣移植再造乳房单侧的经验
- Author:
Dajiang SONG
1
;
Zan LI
;
Yixin ZHANG
Author Information
1. 湖南省肿瘤医院肿瘤整形外科，长沙 410008
- Keywords:
Breast neoplasms;
Posteromedial thigh flap;
Breast reconstruction
- From:
Chinese Journal of Plastic Surgery
2023;39(2):190-198
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the technical highlights and pitfalls in unilateral breast reconstruction with bilateral free posteromedial thigh flaps simultaneously.Methods:Clinical data of patients who received one-staged or delayed unilateral breast reconstruction with bilateral free posteromedial thigh flaps transplantation after modified radical mastectomy were collected and retrospectively analyzed, from October 2018 to December 2020 in the Department of Oncology Plastic Surgery, Hunan Cancer Hospital. There are six types of posteromedial femoral flap: femoral artery perforator flap; gracilis myocutaneous flap; magnus adductor perforator flap; semimembranous muscle perforator flap; posterior femoral cutaneous nerve nutrient vessel perforator flap; sciatic nerve nutrient vessel perforator flap. There are 4 types of vascular anastomosis: (1) supercharge mode 1, the proximal and distal ends of the internal mammary vessels were anastomosed with the vascular pedicle of the bilateral flaps; (2) supercharge mode 2, anastomosis of internal mammary vessels and thoracodorsal vessels with vascular pedicles of bilateral flaps; (3) turbocharge mode, the internal mammary vessels were anastomosed with the vascular pedicle of one side of the flap, and the vascular pedicle branches of the flap were anastomosed with the vascular pedicle of the other side of flap; (4) supercharge mode combined with turbocharge mode, flexible combination of internal mammary vessels and two sets of flap vascular pedicles. There are three ways to place the posteromedial thigh flaps: horizontal placement; vertically placement; obliquely placement. The survival of the flaps, the shape of the reconstructed breast, the scar in the donor area, the influence on lower limb function and the recurrence of breast cancer were followed up.Results:A total of 12 patients were included, with a mean age of 27 to 47 years (mean 37.4±3.6). 7 cases on the left and 5 cases on the right. There were 8 cases of one-staged breast reconstruction and 4 cases of delayed breast reconstruction. A total of 24 medial thigh flaps were harvested, including femoral artery perforator flap in 1 case, gracilis myocutaneous flap in 6 cases, magnus adductor perforator flap in 14 cases, semimembranous muscle perforator flap in 1 case, posterior femoral cutaneous nerve nutrient vessel perforator flap in 1 case, and sciatic nerve nutrient vessel perforator flap in 1 case. Vascular anastomosis mode included: supercharge mode 1 in 5 cases; supercharge mode 2 in 4 cases; turbocharge mode in 2 cases; supercharge combined with turbocharge in 1 case. The flap placement method included: horizontal placement in 3 cases, vertically placement in 4 cases and obliquely placement in 5 cases. The length of flap was (20.6±0.4) cm, width was (7.1±0.3) cm and thickness was (3.6±0.5) cm. The length of vascular pedicle was (6.9±0.5) cm, the diameter of artery was (1.9±0.3) mm and the diameter of vein was (1.8 ± 0.6) mm. The average weight of the flap was 245 g (165-415 g). Two cases underwent mastopexy on the ipsilateral side, and two cases underwent contralateral breast prosthesis implantation immediately. All flaps survived totally. All 12 patients were followed up for 6-18 months (10.5 months on average) with satisfied result. The reconstructed breasts’ shape, texture and elasticity was good and no flap contracture deformation happened. Only linear scar left in the donor sites, the function of thighs was not affected. No local recurrence happened.Conclusion:The method of flap harvestion, vascular anastomosis and breast shaping in applying bilateral free posteromedial thigh flaps for unilateral breast reconstruction are flexible, need to be selected flexibly to ensure the safety and satisfaction of the outcome. It is especially appropriate for patients with insufficient tissue in the lower abdomen or with unsatisfactory appearance of breast reconstruction with traditional bilateral vascular pedicle deep inferior epigastric artery perforator flap.
