遊離腹部皮弁による乳房再建後に血栓が生じた症例の救済手術の検討

抄録

Brest reconstruction using a free abdominal flap is an effective procedure with excellent patient satisfaction, as it enables substantial restoration of breast form and softness. In recent years, deep inferior epigastric artery perforator flaps, which preserve the rectus abdominal muscle, have become less invasive and widespread. High success rates have been reported due to technical refinements and advances in anatomical knowledge. However, the risk of free flap necrosis due to thrombosis remains. We report a series of re-operated cases suspected of postoperative thrombosis after breast reconstruction using free abdominal flaps between April 2013 and March 2020. A total of 308 cases and 342 flaps were assessed, and 21 cases required re-operation due to suspected thrombosis. We detected main perforator thrombosis in 19 of the 21 cases. Variables, such as the time from the initial operation until thrombosis detection, the time from detection to re-operation, findings of the flap, presence of thrombosis, and postoperative course, were retrospectively analyzed. Thirteen cases were diagnosed within 24 post-operative hours and eight re-operated within 5 hours were salvaged. Five cases were diagnosed 4 or more days after the initial operation and only one was salvaged. In the case of late-onset thrombosis, detection was often delayed. It is important to detect thrombosis early and to re-operate within 5 hours.