延期乳房再造中应用单蒂TRAM皮瓣移植重建自然形态的乳房

Restoring a natural-appearing breast in delayed breast reconstruction with a unilateral pedicled TRAM flap

目的:探讨乳癌根治术后延期乳房再造中应用单蒂腹部横形腹直肌肌皮瓣(transverse rectus abdominis musculocu taneous,TRAM)重塑自然形态乳房的方法。方法:2004年7月～2007年10月,笔者应用单蒂TRAM皮瓣对15例患者进行延期乳房再造。于较正常侧高1～2cm的位置设计患侧新乳房下皱襞,切除范围为新乳房下皱襞与乳癌根治术后切口瘢痕之间的皮肤,TRAM皮瓣修复瘢痕切除后创面。结果:所有患者术后随访4～26个月,平均随访15.2个月,效果优10例,良3例,一般2例。2例患者出现TRAM皮瓣II区皮下脂肪坏死,经引流后愈合,1例患者乳房下皱襞较健侧低,二期修复后手术效果为优。结论:本组病例应用的技术有利于再造乳房呈现自然形态,避免明显补丁样畸形。

Objective To investigate the technique of restoring a natural-appearing breast in delayed breast reconstruction after mastectomy with unilateral pedicled transverse rectus abdominis musculocutaneous（TRAM） flap.Methods During July 2004 to October 2007,15 patients underwent delayed breast reconstruction with unilateral TRAM flaps.The inframam may fold is designed 1～2 cm higher than that of normal breast.The skin of area between the mastectomy scar and the marked imframammary fold was resected.The surface of wound was covered with TRAM flap.Results All patients were followed-up 4 to 26 months,average month was 15.2.Cosmetic evaluation of the reconstructed breasts showed excellent results was 10 patients,good results was 3 patients and fair result was 2 patients.Fat necrosis in the zone II of TRAM flap developed in two patients and resolved after irrigations.Lower inframammary fold occur in one patient and resolved by secondary revision with excellent result.Conclusions The applicaition techniques in the group was beneficial to mammaplasty which showed natural state,and avoid clear patch malformation.