Fujiwara Masao, Nakamura Yoko, Sano Akira, Nakayama Ei, Nagasawa Miyuki, Shindo Toru
Department of Plastic and Reconstructive Surgery, Tenri Hospital, 200, Mishima, Tenri, Nara, 632-8552, Japan.
Aesthetic Plast Surg. 2006 Jan-Feb;30(1):120-4. doi: 10.1007/s00266-005-0145-6.
Not only is a radiation ulcer nonviable itself, but the surrounding irradiated tissue also shows poor healing. Therefore, healing in an irradiated field cannot be expected if a flap used for reconstruction fails even partially. For repair of radiation ulcers, a flap with a stable blood supply is required. A superiorly based vertical rectus abdominis myocutaneous (VRAM) flap is commonly used for chest wall reconstruction. Because the VRAM flap is nourished only by the superior epigastric vessels, the blood supply to the distal part of the flap often is precarious.
A case is reported in which a delayed VRAM flap was used successfully to treat a radiation ulcer on the anterior chest wall.
Consecutive angiograms showed that the delay procedure augmented the blood supply to the VRAM flap. The flap showed complete take without any postoperative complications.
A delay procedure may make the VRAM flap more reliable for anterior chest wall reconstruction. This flap may be a valuable option for reconstruction of intractable ulcers such as radiation ulcers, and may be applicable for breast reconstruction after radiation therapy.
放射性溃疡本身就没有活力，而且其周围的受照射组织愈合能力也很差。因此，如果用于重建的皮瓣哪怕只是部分失败，都不能指望在受照射区域实现愈合。对于放射性溃疡的修复，需要一个血供稳定的皮瓣。上蒂垂直腹直肌肌皮瓣（VRAM瓣）常用于胸壁重建。由于VRAM瓣仅由腹壁上血管供血，皮瓣远端部分的血供往往不稳定。
本文报告了一例成功使用延迟VRAM瓣治疗前胸壁放射性溃疡的病例。
连续血管造影显示延迟手术增加了VRAM瓣的血供。皮瓣完全成活，术后无任何并发症。
延迟手术可能会使VRAM瓣在前胸壁重建中更可靠。这种皮瓣可能是重建难治性溃疡（如放射性溃疡）的一个有价值的选择，并且可能适用于放疗后的乳房重建。
