Hudson D A, van Zyl J E, Duminy F J, Silfen R
Department of Plastic and Reconstructive Surgery, Groote Schuur Hospital, Cape Town, Africa.
Aesthetic Plast Surg. 2000 May-Jun;24(3):202-5. doi: 10.1007/s002660010033.
The TRAM flap has become the gold standard in breast reconstruction but suffers from the disadvantages of poor color match, different texture, and impaired sensation compared to the normal breast. This study reports on a two-stage procedure to address these problems. The first stage consists of insertion of a tissue expander and surgical delay of the TRAM flap. The second stage consists of removal of the tissue expander and transposition of a deepithelized TRAM flap into the tissue expanded cavity. (The capsule is excised.) Four cases of breast reconstruction are reported. The advantage of this procedure is that it offers the benefits of tissue expansion, viz., normal color match, texture, and sensation, and in addition, reconstruction is achieved with autologous tissue by a pedicled TRAM flap. The vascularity of the TRAM is enhanced by a surgical delay procedure.
横行腹直肌肌皮瓣（TRAM瓣）已成为乳房重建的金标准，但与正常乳房相比，存在颜色匹配不佳、质地不同以及感觉受损等缺点。本研究报告了一种分两阶段的手术方法来解决这些问题。第一阶段包括植入组织扩张器和对TRAM瓣进行外科延迟处理。第二阶段包括取出组织扩张器以及将去上皮化的TRAM瓣转移至组织扩张后的腔隙（切除包膜）。报告了4例乳房重建病例。该手术方法的优点在于它兼具组织扩张的益处，即颜色匹配正常、质地和感觉正常，此外，通过带蒂TRAM瓣利用自体组织实现了重建。TRAM瓣的血运通过外科延迟手术得到增强。
