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目的总结乳腺癌根治术后二期应用岛状背阔肌肌皮瓣加乳房假体行乳房再造术及腋前皱襞重建的手术方法及临床疗效。方法2006年12月-2008年3月,收治11例乳腺癌根治术后1～4年胸壁严重缺损患者;年龄27～49岁。左侧3例,右侧8例。术中采用背阔肌止点离断的岛状背阔肌肌皮瓣旋转替代胸大肌,背阔肌肌瓣切取范围26cm×17cm～31cm×20cm,皮瓣切取范围13cm×6cm～18cm×8cm。于肌瓣后间隙植入乳房假体,背阔肌前上缘固定于腋顶及腋前线填补腋顶空虚并重建腋窝前皱襞。供区直接缝合。结果术后再造乳房全部成活,供受区切口均Ⅰ期愈合。11例均获随访,随访时间3～14个月。再造乳房外观自然,手感良好,重建的腋前皱襞与健侧基本对称,腋顶及腋前皱襞凹陷畸形基本纠正。结论应用背阔肌止点离断的岛状背阔肌肌皮瓣加乳房假体行乳房再造及腋前皱襞重建是修复乳腺癌根治术后较严重缺损的较好方法之一。
OBJECTIVE: To summarize the surgical methods and clinical outcomes of second-stage post-operative radical mastectomy with latissimus dorsi myocutaneous flaps and breast implants in breast reconstruction and axillary fold reconstruction. Methods From December 2006 to March 2008, 11 patients with severe chest wall defect 1 to 4 years after radical mastectomy of breast cancer were treated. The patients were 27 to 49 years old. 3 cases on the left and 8 cases on the right. Intraoperative use latissimus dorsi latissimus dorsi latissimus dorsi muscle flap rotation instead of pectoralis major muscle, latissimus dorsi muscle flap removal range of 26cm × 17cm ~ 31cm × 20cm, skin flap range of 13cm × 6cm ~ 18cm × 8cm. Breast implants were implanted in the posterior region of the muscle flap. The anterior margin of the latissimus dorsi was fixed to the axillary crest and the anterior axillary line to fill the empty axillary crest and reconstruct the armpit anterior fold. The area for direct suture. Results All breast reconstruction surgery survived for incision healed by first intention. Eleven patients were followed up for 3 to 14 months. Rebuilt breast appearance naturally, feel good, the reconstruction of the axillary folds and the contralateral basic symmetry, armpit and armpit fold folds deformity basic correction. Conclusion The application of latissimus dorsi myocutaneous flaps and breast implants in the reconstruction of latissimus dorsi and reconstruction of axillary folds is one of the better methods to repair more serious defects after radical operation of breast cancer.