穿支定位在原瘢痕区切取腹壁下动脉穿支皮瓣的意义:附一例报道

摘要

目的 探讨穿支定位在腹壁瘢痕患者切取腹壁下动脉穿支皮瓣(DIEP)时的作用. 方法 术前用多排螺旋CT血管造影(MDCTA),以确定有未被损伤及足够粗的腹壁下动脉皮瓣穿支,术中探查已定位穿支血管,分离腹壁下动脉穿支及皮瓣,二期乳房再造1例. 结果 术前最优穿支体表定位位置与术中吻合,最大穿支位置位于脐水平左侧约2.8 cm处的垂直下方2.0 cm,内径1.3 mm.皮瓣成活好,术后随访半年,再造乳房外形良好,总体修复效果优良. 结论 腹壁瘢痕并非DIEP皮瓣的绝对禁忌手术指征,术前MDCTA可提供准确的腹壁下动脉穿支解剖学信息,术中探查最优穿支血管,保证了皮瓣的血运.穿支定位可作为原瘢痕区切取皮瓣的术前常规检查.%Objective To investigate the effect of perforator identification before DIEP flap dissection for the patient with abdominal scar.Methods Preoperative multidetector-row computed tomography angiography was used to identify that the dominant perforators of the abdominal wall were not damaged completely.During the second stage breast reconstruction operation,the located dominant perforator and the DIEP flap were dissected.Results The dominant perforator located by MDCTA was identified with the exploration in operation.Follow-up for half a year,the flap survived well and the patient was satisfied with the appearance.Conclusion Abdominal scar was not the definite contraindication for DIEP flap.MDCTA provided a good quality evaluation of the perforator vessels.The located dominant perforator was dissected to confirm the blood supply of the DIEP flap.Identification of perforator can be used as a routine preoperative evaluation for patients with scar on donor site.