Skate flap purse-string法—再建乳房の輪郭を損なわない局所皮弁による乳頭再建—

The Skate Flap Purse-String Technique: Nipple Reconstruction without Compromising Reconstructed Breast Contours through Donor Site Closure

はじめに

　乳頭・乳輪の再建は再建乳房をより乳房らしくさせる重要な行程であり，その結果は患者満足度に大きな影響を与える 1）。再建方法についてはさまざまな選択肢があるが 2），特に局所皮弁による乳頭再建は，乳頭の聳立の維持が大きな課題である 3）。突出を高くするために皮弁を大きくデザインすると，皮弁採取部の閉鎖により再建乳房の歪みや平坦化を生じるというジレンマがある。Skate flap purse-string法は，皮弁採取部を巾着縫合によって円形に締め上げて閉鎖することで，再建した乳頭に向かって乳房頂部が突出したような，本来の乳房形態に近づく利点がある 4）。著者らはskate flap purse-string法に若干の改良を加えて実施しており，手術方法と術後管理について考察を加え報告する。

　Reconstruction of the nipple-areola complex is a crucial step in making a reconstructed breast look more natural, and the aesthetic outcome greatly impacts patient satisfaction. Although there are various options for reconstructive methods, maintaining nipple projection remains a significant challenge, especially in nipple reconstructions that use local flaps. Designing a larger flap to achieve higher projection can lead to a dilemma in which closing the donor site causes distortion or flattening of the reconstructed breast. The skate flap purse-string technique addresses this issue by closing the donor site with a circular purse-string suture, resulting in a morphology in which the apex of the breast protrudes towards the reconstructed nipple, thereby achieving a more natural breast shape. We have made some modifications to the skate flap purse-string technique, and we describe the surgical technique and postoperative management.