Patients requiring breast reconstruction following radiation therapy or prior failed autologous breast reconstruction (ABR) or implant-based breast reconstruction (IBBR) represent a challenging cohort and often present with compromised vascularity, scarred anatomy, and subsequent increased rates of complications. In this review, we discuss microsurgical strategies designed to optimize donor tissue in these challenging clinical scenarios, including the use of stacked or bipedicled flaps, and the utility of intraoperative indocyanine green angiography. We also review approaches to alternate recipient vessel selection in the suboptimal chest, and we address specific strategies for the revision setting, like soft tissue support and hybrid reconstruction with ABR and IBBR. By synthesizing the current literature and expert experience, this narrative review provides a practical framework for microsurgeons managing complex breast reconstruction in higher-risk patients.
对于接受放射治疗后或先前自体乳房重建（ABR）或植入物乳房重建（IBBR）失败的患者而言，其乳房重建过程极具挑战性。这类患者常伴有血管条件不佳、解剖结构瘢痕化等问题，从而导致并发症发生率升高。本综述探讨了针对此类复杂临床情况设计的显微外科策略，旨在优化供体组织利用，包括采用堆叠式或双蒂皮瓣技术，以及术中吲哚菁绿血管造影的应用价值。同时，我们回顾了在胸部条件欠佳情况下选择替代受区血管的方法，并探讨了修复手术中的特定策略，如软组织支撑技术及ABR与IBBR相结合的混合重建方案。通过整合现有文献与专家经验，本叙述性综述为显微外科医生处理高风险患者的复杂乳房重建提供了实用框架。
肿瘤(癌症)患者之家