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Title: [Clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction].
Author: Song DJ, Peng W, Li Z, Zhou X, Zhang YX, Feng G, Peng XW, Zhou B, Lyu CL, Ou Y, Mao HX, Liu ZY, Li H.
Journal: Zhonghua Shao Shang Za Zhi; 2019 Apr 20; 35(4):277-283. PubMed ID: 31060175.
Abstract:
Objective: To explore the clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction. Methods: From October 2014 to December 2016, 10 female patients, aged 37-60 (48±8) years, who had lymphedema in the upper limb after radical mastectomy, were admitted to Department of Oncology Plastic Surgery of Hunan Cancer Hospital. Three patients suffered recurrent erysipelas infections, and 4 patients suffered consistent neuropathic pain in the upper limb. Free deep inferior epigastric perforator flap carrying lymphatic groin flap was used for breast reconstruction and lymphedema treatment. Operation was performed by 2 surgeon groups including recipient site prepare group and flap harvest group. In the 10 patients, the length of the flaps was (26.2±0.3) cm, the width of the flaps was (13.4±0.4) cm, and the thickness of the flaps was (3.4±0.3) cm. All the donor sites in the abdomen were closed directly. The choices of vascular pedicles and vessels in the recipient sites, operation time, complications, operation effects, and follow-up were recorded. Results: (1) Bilateral vascular pedicle was adopted in flaps of 5 patients. Unilateral vascular pedicle was adopted in flaps of 5 patients. The recipient vessels were proximal and distal ends of internal thoracic vessels in 4 cases, the proximal end of thoracodorsal vessels in 3 cases, the proximal end of internal thoracic vessels in 2 cases, and the proximal end of internal thoracic vessels and thoracodorsal vessels in 1 case. (2) The operation time of the patients was 330-480 (406±55) min. (3) Subcutaneous edema was observed in flaps of 2 patients and donor site of 1 patient, which were all healed by dressing change therapy. The other flaps survived successfully. The reconstructed breasts were in good shape and elasticity. Nine patients had different degrees of relief in lymphedema in the upper limb. All 10 patients were followed up for 6 to 28 months, no one had recurrent erysipelas infections, and neuropathic pain in the upper limb was relieved in 2 patients. Only linear scar was left in the donor sites of 10 patients, and the function of abdomen was not affected without related complications. Conclusions: Free deep inferior epigastric perforator flap carrying lymphatic groin flap can simultaneously accomplish breast reconstruction and upper limb lymphedema treatment, which is worthwhile to be popularized in clinic. 目的：探讨采用携带髂腹股沟淋巴组织瓣的游离腹壁下动脉穿支皮瓣移植治疗乳腺癌根治术后并发上肢淋巴水肿并再造乳房的临床效果。 方法：2014年10月—2016年12月，湖南省肿瘤医院肿瘤整形外科收治10例乳腺癌根治术后并发上肢淋巴水肿的患者，均为女性，年龄37～60(48±8)岁，其中3例合并上肢丹毒反复发作、4例有持续性上肢神经痛。采用携带髂腹股沟淋巴组织瓣的腹壁下动脉穿支皮瓣游离移植治疗，手术分"受区准备组"和"皮瓣切取组"同时进行。本组患者皮瓣长(26.2±0.3)cm、宽(13.4±0.4)cm、厚(3.4±0.3)cm，腹部皮瓣供区直接拉拢缝合。观察并记录血管蒂和受区血管选择、手术时间、并发症、手术效果及随访情况。 结果：(1)本组5例患者皮瓣为双侧血管蒂，5例患者为单侧血管蒂。4例患者皮瓣选用胸廓内血管近远端、3例患者皮瓣选用胸背血管近端、2例患者皮瓣选用胸廓内血管近端、1例患者皮瓣选用胸廓内血管近端和胸背血管近端作为受区血管。(2)手术时间为330～480(406±55)min。(3)2例患者皮瓣发生皮下血肿，1例患者供区发生皮下血肿，经换药治疗后全部愈合，其余皮瓣均顺利成活，再造乳房外形可、弹性好，9例患者上肢淋巴水肿症状得到不同程度缓解。10例患者获随访6～28个月，无一例复发丹毒等皮肤感染症状，2例患者的患肢神经痛得到缓解；10例患者腹部供区仅遗留线性瘢痕，腹部功能无明显受限，未见相关并发症。 结论：采用携带髂腹股沟淋巴组织瓣的游离腹壁下动脉穿支皮瓣移植可以同时再造乳房并治疗上肢淋巴水肿，值得临床推广。.

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