三叶状下腹部腹直肌肌皮瓣乳房重建

Breast reconstruction using pedicled three-lobe transverse rectus abdominis musculocutaneous flap

目的用改善血供的下腹部横行腹直肌肌皮瓣(TRAMF)重建乳房。方法在通常以上部腹直肌为蒂的 TRAMF 的肌蒂表面附加一块脐旁三角形皮瓣,使共同组成三叶状,藉以增加肌皮穿支动脉的血供及肌皮瓣提供的组织量,便于乳房塑形和腋部瘢痕挛缩的充分松解修复,以及胸壁的放射性烧伤创面的修复。结果乳癌术后单侧乳房缺失伴胸壁放射性溃疡及腋部瘢痕挛缩6例,肌皮瓣完全成活者4倒,皮瓣最远端少量坏死及脂肪液化者2例。重建乳房外形良好,胸壁放射性烧伤创面修复及腋部瘢痕挛缩修复。结论本术式最适用于单侧乳房缺失伴放疗后有胸壁烧伤溃疡及腋窝瘢痕挛缩的病例。

Objective An innovated transverse rectus abdominis musculocutaneous flap,the three- lobe TRAM flap was designed for breast reconstruction.Methods A triangle-shaped skin over the upper part of the rectus abdominis muscle was included in the conventional TRAM flap for the purpose of adding more skin for breast reconstruction and enhancing blood supply of the skin portion of the TRAM flap.Re- suits In this group of six patients subjected to mastectomy and radiation therapy for breast cancer,com- plete survival of the three-lobe TRAM flap was obtained in 4 cases.Two patients had minor skin necrosis and fat liquefaction.Better breast contour and contracture release of the axilla were also achieved.Conclu- sion This innovation of conventional TRAM flap for breast reconstruction has some advantages.It is es- pecially useful for patients complicated with radiation lesions on the chest and axilla areas.