Using Free Superior Gluteal Artery Perforator Flap for Breast Reconstruction in Asian Women

使用上臀動脈穿透枝皮瓣對亞洲婦女進行乳房重建

高煌凱(Huang-Kai Kao) ； 鄭明輝(Ming-Huei Cheng) ； 陳煥棠(Hwan-Tan Chen) ； 魏福全(Fu-Chan Wei)

《中華民國整形外科醫學會雜誌》 13卷1期 (2004/03) Pp. 17-26

https://doi.org/10.7096/JPSA.200403.0017

摘要

以自體組織進行乳房重建會有較為自然和美麗的外觀不論是根蒂性或是自由皮瓣。下腹部的組織通常是最常見的供應區，對於下腹部組織不足以作乳房重建，之前曾做過腹部整形術，下腹部有縱切疤痕，或是計劃懷孕的病人都是以下腹部皮瓣進行乳房重建的禁忌。在這種狀況下，能夠提供大量的表皮與脂肪的臀部是另一種好的選擇。上臀動脈穿透枝皮瓣是由臀大肌皮瓣演化而來，它提供較長的血管長度且不致因切除部分臀大肌而導致肌肉無力的情形發生。自1999年至2002年，於長庚醫院共有七個病人以上臀動脈穿透枝皮瓣進行乳房重建。三個病人屬於延遲性，立即性重建的病人也有三個，另一個是波蘭氏症候群。皮瓣重量平均是425克。大小從9×20公分到10×28公分。血管平均長度是8公分。除了一個皮瓣失敗外其餘都存活。發生靜脈循環不良的一個病人之後有脂肪壞死與部分皮瓣喪失的現象。大部分的病人對重建的乳房感到滿意。因此當下腹部不能作為乳房重建的供應區時，以上臀動脈穿透枝皮瓣進行乳房重建是另一個好的選擇。

並列摘要

Breast reconstruction with autologous tissue transfer could achieve more natural and cosmetic results. To date, the lower abdominal-wall tissue is the most commonly used donor site, either as a pedicled or free flap. However, there are some contraindications for using lower abdominal flaps in breast reconstruction, including inadequate soft tissue volume, previous abdominoplasty, and low paramedian or longitudinal abdominal scars. In such situations, the gluteal area, which provides large ample amount of skin and fat even in thin patients, is a good alternative. The superior gluteal artery perforator flap is the revolution of the traditional gluteus maximus myocutaneous flap, which was innovated to minimize the donor site morbidity and to provide a longer pedicle. From 1999 to 2002, seven unilateral breast reconstruction in seven patients were performed using superior gluteal artery perforator flap at Chang Gung Memorial Hospital. Three of them were delayed, three as immediate reconstructions and Poland's syndrome in one case. The flap weighted from 330 gm to 635 gm, mean 425 gm. Skin islands ranged in size from 9×20 cm to 10×28 cm. The mean pedicle length was 8 cm (ranged, 6 to 10 cm). All flaps survived except one flap failure as a result of artery insufficiency. One case suffered from venous congestion postoperatively and had following a partial flap loss and fat necrosis.
This method could provide an improvement in contour and projection of the reconstructed breast with minimal donor site morbidity.
Therefore, when an abdominal flap is unavailable or contraindicated, the superior gluteal artery perforator flap is an alternative for immediate and delayed breast reconstruction.

並列關鍵字

superior gluteal artery perforator SGAP flap ； breast reconstruction