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游离穿支交叉腹直肌肌皮瓣用于乳房重建。

Free perforator crossover TRAM flap for breast reconstruction.

作者信息

Lam Thomas C, Sellars Graham D

机构信息

Department of Plastic and Reconstructive Surgery, N.S.W. Breast Cancer Institute, Westmead Hospital, Sydney, Australia.

出版信息

Ann Plast Surg. 2003 Feb;50(2):126-31. doi: 10.1097/01.SAP.0000032307.61429.9E.

Abstract

Breast reconstruction using a transverse rectus abdominis musculocutaneous (TRAM) flap has become the preferred method of autogenous reconstruction for most surgeons. The vascular basis of both the superior and inferior vascular pedicles of this flap has been well documented. When a pedicled TRAM flap is based superiorly, the perfusion across the midline to zone 4 and sometimes zone 3 is, at best, variable. Augmentation of the blood supply of the contralateral side with various methods has been reported. The methods include the delay procedure, bipedicled flaps, supercharging, and turbo-charging. The deep inferior epigastric artery is the dominant blood supply, and a microsurgical free TRAM flap based inferiorly provides reliable perfusion, even to zone 4, which obviates the need for many of these maneuvers. It has also been demonstrated that the circulation across the midline in a TRAM flap is primarily by means of a subdermal plexus and that with a previous vertical midline abdominal scar there is virtually no midline crossover at any anastomotic level. Therefore, even with a free TRAM flap based on the dominant inferior pedicle, perfusion across a vertical midline scar is unreliable. As a result, many patients with a vertical midline scar have been denied the best autogenous reconstructive option. The authors present their experience with a free perforator crossover TRAM flap using a constant premuscular branch of the deep inferior epigastric artery and vein that provides many patients who have a previous midline scar with a genuine option for autogenous tissue breast reconstruction.

摘要

对于大多数外科医生来说,使用腹直肌横形肌皮瓣(TRAM瓣)进行乳房重建已成为自体组织重建的首选方法。该皮瓣上、下血管蒂的血管基础已有充分记录。当带蒂TRAM瓣以上方为蒂时,向4区甚至有时向3区的中线灌注充其量是不稳定的。已有报道采用各种方法增加对侧的血供。这些方法包括延迟手术、双蒂皮瓣、增压和超增压。腹壁下深动脉是主要的血供来源,基于下方的游离TRAM瓣显微外科手术能提供可靠的灌注,甚至到4区,这就避免了许多此类操作的需要。也已证明,TRAM瓣的中线血液循环主要通过皮下丛进行,并且有既往垂直中线腹部瘢痕时,在任何吻合水平几乎都没有中线交叉。因此,即使是基于主要下方蒂的游离TRAM瓣,通过垂直中线瘢痕的灌注也是不可靠的。结果,许多有垂直中线瘢痕的患者被剥夺了最佳的自体组织重建选择。本文作者介绍了他们使用腹壁下深动脉和静脉恒定的肌前分支的游离穿支交叉TRAM瓣的经验,这为许多有既往中线瘢痕的患者提供了真正的自体组织乳房重建选择。

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