Plastic Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., 1st. floor, C1991ABB, Buenos Aires, Argentina.
Head and Neck Surgery Section, General Surgery Department, Hospital Italiano de Buenos Aires, University of Buenos Aires Medical School, Hospital Italiano de Buenos Aires University Institute (IUHIBA), 4190 Peron St., C1181ACH, Buenos Aires, Argentina.
背景
几十年来，胸大肌皮瓣一直被认为是头颈部重建的主力。然而，胸肌皮瓣的缺点包括供体部位在美容和功能结果方面的发病率。硅胶胸肌植入物可以用来解决男性患者的这种审美胸部畸形。
方法
一名33岁男性，因摩托车事故造成钝性外伤后有颈部气管食管瘘病史，之前曾用胸大肌瓣进行重建，因供体部位美观缺陷而向我院整形外科咨询。计划使用解剖学胸肌植入物，目的是重塑男性胸部的美观。根据术前设计创建了一个口袋，用于放置 190 cc 的胸肌植入物。在皮下平面进行解剖，包括下面的脂肪组织层，然后是胸小肌和锯肌。三个月后，在第二阶段，用从腹部获得的100毫升脂肪组织对凹陷区域进行脂肪填充。
结果
经过两年的随访，患者获得了满意的美学效果，胸部的投影和身体轮廓的对称性得到改善。当植入物被放置到皮下袋中时，在随访期间没有检测到肩部屈曲或内收的功能损害。
结论
胸肌植入技术似乎很安全，并且可以重塑男性胸壁，显着改善患者的外观。此外，它与脂肪填充等相关手术一起使用可以获得最佳结果。据我们所知，这是第一个描述使用胸肌植入物来解决出于任何重建目的而获取胸肌皮瓣后供体部位发病率的案例。
证据级别 V
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Background
The pectoralis major musculocutaneous flap has been considered for decades the workhorse in head and neck reconstruction. However, the disadvantages of the pectoralis flap include the morbidity of the donor site in terms of cosmetic and functional results. A silicone pectoral implant can be used to solve such aesthetic chest deformity in male patients.
Methods
A 33-years-old man with a history of cervical tracheoesophageal fistula after a blunt trauma due to a motorcycle accident, previously reconstructed with a pectoralis major flap, consulted our Plastic Surgery Department for an aesthetic defect of the donor site . The use of an anatomical pectoral implant was planned with the aim of aesthetic reshaping of the male chest. A pocket was created following the preoperative design to position a 190 cc pectoral implant. Dissection was performed in a subcutaneous plane that included the underneath adipose tissue layer and then over the pectoralis minor and the serratus muscle. Three months later, in a second stage, lipofilling of the depressed areas was performed with 100 ml of adipose tissue obtained from the abdomen.
Results
After two years of follow-up, the patient obtained a satisfactory aesthetic result, with an improvement in the projection of the thorax and the symmetry of the body contour. As the implant was placed into the subcutaneous pocket, no functional compromise in shoulder flexion or adduction was detected during follow-up.
Conclusions
The pectoral implant technique seems safe and provides reshaping of the male chest wall, significantly improving the cosmetic appearance of the patient. In addition, its use with associated procedures such as lipofilling allows optimal results to be obtained. To the best of our knowledge, this is the first case to describe the use of a pectoral implant to solve donor site morbidity after pectoralis flap harvesting for any reconstructive purpose.
Level of Evidence V
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