剖宫产术后行横行腹直肌肌皮瓣乳房再造的应用策略

Strategy of breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap

目的探讨剖宫产后瘢痕者行横行腹直肌（1ransversereelusabdominismyocutaneous，TRAM）肌皮瓣乳房再造的可行性和于术策略。方法对12例有削宫产史的乳腺癌患者实施TRAM肌皮瓣乳房再造术。所有患者的TRAM肌皮瓣臆用危险因素评分均为0．5分，Ⅱ类。采用腹部倒梯形手术切口，切口上缘下距脐2～3cm，对1例腹部纵切口瘢痕较长者采用腹直肌双蒂，其余均为患乳对侧腹冉肌单蒂，并携带同侧腹直肌前鞘，对腹伐肌和前鞘缺损以聚丙烯网片修补。结果令鄢12例皮瓣成活．尤腹部并发症发生，随访3～52个月，满意率达100％。结论带剖宫产瘢痕者行TRAM肌皮瓣乳房再造需严格选择病例，并要求制定卡目应的手术策略。

Objective To investigate the availability and strategy of breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap. Methods From January 2007 to May 2011, 12 cases of breast reconstrtlction with caesarotomy scar were carried out with pedicted TRAM flaps. All the patients that were classified as the class 11 that was 0.5 or less by score were operated on by using the inverted trapezoid incision, of which the upper edge was 2 or 3 em clown to the umbili- cus. Double pedicles were adopted for the patient with the longest vertical scar; single pedicle of the breast eontralateral side and the muscle sheath of the breast ipsilateral side were harvested for the rest of the patients. A synthetic mesh was used for the enforcement of the muscle and sheath defect. Re- sults No flap necrosis or abdominal complications were observed. With the follow-up from 3 months to 4 years and 4 months, the overall satisfactory rate was 100 %. Conclusions The strict patient se- lection and the operating strategy are the keys to the successful breast reconstruction for patients with caesarotomy scar using pedicled TRAM flap.