脂肪筋膜瓣乳房整形 陈祖锦PPT课件

.,Adipofascialflap,天津市肿瘤医院乳腺一科陈祖锦,11,.,基于乳腺切除的量及手术相对难度将OPS分为两级,.,保乳术后乳房整形,VolumeReplacement用非乳腺织进行替代填充,.,VolumereplacementtechniquesAdipofascialflapLateralthoracodorsalflapThoracoepigastricflapIntercostalarteryperforator(ICAP)flapThoracodorsalarteryperforator(TDAP)flapLatissimusdorsi(LD)myocutaneousflap,.,ProcedureforharvestingtheC-shapedthoracodorsalapandrepairofthedefect.(A)Bythesameskinincisionuponthemiddleaxillaryline,wecandothepartialresectionofthebreast,axillarylymphnodedissection,andgettheadipofascialap.(B)AC-shapedthoracodorsaladipofascialapwasharvestedafterlocalresectionofthebreastandaxillarylymphnodedissection.(C)Attachingthefasciaofthelatissimusdorsimuscletotheadiposetissuemakestheharvestedtissuerm.(D)Theapisrotatedtothemedialsidetollthedefect.Wesometimesrollorgatherittoreconstructtothebreastmound.,Thoracodorsaladipofascialap,.,42-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case1)(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thedeformityofbothbreastanddonorsiteisinconspicuous.,.,6-year-oldladywithbreastcancerlocatedonupperouter-quadrantoftherightbreast(Case2).(A)Aresectedareaofthebreastwiththegrossmarginas3cmandaC-shapedthoracodorsaladipofascialapwasmarkedbeforesurgery.(BandC)6monthspost-surgery.Thecosmeticresultwasexcellent.,.,Modiedthoracodorsaladipofascialcutaneousap,.,.,.,.A27-year-oldwomanwithbreastcancerlocatedintheupper-outerquadrantoftherightbreast(Case2).(A)Amodiedthoracodorsaladipofascialcutaneousapwasdesignedsothatitcouldbeharvestedviaanincisionalongtheanterioraxillarylineandanadditionalbackincision.(B)(C)Sixmonthspostsurgery.Thebilateralincisionswereinconspicuousfromtheanteriorview,.,.,.,Thelocalndings1yearafterthesurgery,.,Freedermalfatgraft(FDFG),A57-year-oldpatientwithaslimbodyandnon-ptoticbreasts(case2)(A)Preoperativefindings;(B)Anincisionlinewasdrawninredacrossthenipple.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasimplantedinthecylinder-shapeddeformityinthecentralbreast;(C)Fouryearsaftersurgery.,.,A58-year-oldpatientwithPagetsdiseaseintherightbreast(case3).(A)Preoperativefindings;(B)Anincisionlinewasdrawninred.Thenipple,butnottheareolawasremovedtogetherwiththebreasttissue.Afreedermalfatgraft(FDFG)fromthelowerabdomenwasharvestedforimplantationintothebreastdefect(15,16);(C)Sevenyearsaftersurgery.,.,(a)Insitude-epithelializationoftheentireskinpaddlewasperformed.(b)Anellipseoffatanddermiswasremovedbysharpdissection.(c)TheFDFGwasturnedoversothatthedermisfacedthesurfaceofthepectoralismajorandwasxedsecurelyalongtheentireperiphery.,Figure5UltrasonographyrevealedgoodFDFGvolumeoneyearaftertheoperation(F:FDFG,G:normalgland).,.,Case1:preoperativemarkingsoftheareatoberesectedina53-year-oldpatientwithaT1tumorinthelower-outerquadrantoftheleftbreast.aApurplespotformedaftercoreneedlebiopsy(CNB).Herbreastswerenotptotic.b,cThecancerlesionandthescarinthe6oclockpositionleftbytheCNBarecircledinred.Theincisionlineisdrawninredalongtheinframammaryline,Inframammaryadipofascialap,.,Operativendings.aAtongue-shapedadipofascialap,10cminlength,wasdrawnasablackdottedline.Acrescentofskinwasde-epithelialized.bTheapwasharvestedviaaninframammaryincisionlineandacaudalwindow.cThede-epithelializedskinwasharvestedtogetherwiththeinframammaryap.dThetissuewasrolleduptowardsthecranialside,.,.,a,binferioradipofascialtissuerepairSkinincisionwasplacedoninfra-mammaryline.c.Thisflapofafatpadhadawideandlinearpedicleontheinferiormammaryline,andwasbackedbymyofascia(break-lineinschema)oftheanteriorserratusmuscle,andoccasionallytheexternalobliquemuscle.d.Wekeptasmanyperforatingbranchesfromthemusclebodyas