在资源有限的情况下使用双侧深动脉穿孔器-免皮瓣进行复杂乳房重建:病例报告

Pub Date : 2024-01-19 DOI:10.1097/io9.0000000000000015
D. O. Otieno, Ruth W. Njoroge, Josiah Moki, A. Okello, Mohamed Dahir
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引用次数: 0

摘要

有趣的是,目前乳房切除术模式的转变和重建技术的进步促使每年要求乳房切除术后重建的患者人数不断增加。根据现有的专业知识,患者可以选择乳房重建(即刻或延迟)、自体或植入物重建。我们介绍了一例 36 岁女性患者的病例,她因右侧乳房浸润性导管癌接受了乳房切除术,术后 5 年病情缓解,现在希望对未受影响的左侧乳房进行风险降低手术(预防性乳房切除术),并立即进行乳房重建。显微外科技术利用双侧大腿深动脉穿孔皮瓣进行(即刻和延迟)乳房重建。在我们的病例中,作者进行延迟乳房重建的一侧(右侧)结果不佳,诊断为静脉功能不全,导致单侧皮瓣完全脱落,随后进行了清创,并用斜向带蒂背阔肌皮瓣进行了重建。相比之下,在左侧进行风险降低手术并立即进行重建后,埋藏皮瓣完全成功,游离乳头移植术后效果良好。
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Complex breast reconstruction using bilateral profunda artery perforator-free-flaps in a resource-limited setting: a case report
Interestingly, the current shift in mastectomy patterns and advances in reconstruction techniques have contributed to an increasing number of patients requesting breast reconstruction postmastectomy every year. Depending on available expertise, patients can access breast reconstruction options (immediate or delayed), autologous, or implant-based. We present a case of a 36-year-old female patient 5 years into remission, having undergone mastectomy for invasive ductal carcinoma of the right breast and now preferred risk reduction surgery (prophylactic mastectomy) of her left unaffected breast with immediate reconstruction. The microsurgical technique utilized bilateral profunda artery perforator flaps from both thighs for (immediate and delayed) breast reconstruction. In our scenario, the authors had an unfavorable outcome on the side of delayed breast reconstruction (right) with a venous insufficiency diagnosis leading to unilateral complete flap loss, which was subsequently debrided and reconstructed with an obliquely-oriented pedicled Latissimus dorsi flap. In contrast, following risk reduction surgery and immediate reconstruction on the left side, the buried flap was a complete success, with the free nipple graft doing well postoperatively.
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