Wu Liza C, Iteld Lawrence, Song David H
Section of Plastic and Reconstructive Surgery, The University of Chicago Hospitals, Chicago, IL 60637, USA.
Ann Plast Surg. 2008 Jun;60(6):609-13. doi: 10.1097/SAP.0b013e318156625b.
Autologous breast reconstruction with the transverse rectus abdominis musculocutaneous (TRAM) flap is traditionally based on either the superior epigastric vessels (pedicled) or the deep inferior system (free). In the overweight and obese population, both techniques have been shown to have increased complications of the reconstructed breast. Another alternative is supercharging the flap by anastamosing the deep inferior epigastric vessels to either the internal mammary or thoracodorsal systems. We present a single surgeon's experience with unilateral TRAM reconstructions supercharged to either the thoracodorsal vessels, the internal mammary system, or in one case, perforator vessels in overweight and obese patients.
Nineteen consecutive overweight or obese patients underwent delayed or immediate, unilateral autologous breast reconstruction with supercharged TRAM flaps between November 2000 and November 2004. The patients ranged in age from 28 to 66 years (average 49) and had an average body mass index (BMI) of 29.5 (24.9-38.3). Twelve patients had a BMI between 25 and 29.9 kg/m2; 7 patients had BMI > or =30 kg/m2. Left-sided reconstructions were 13; right-sided reconstructions were 6. Supercharging was performed by anastamosing the deep inferior epigastric artery and vein to the thoracodorsal vessels, internal mammary vessels, or perforator vessels.
Follow-up ranged from 6 to 54 months. There was a qualitative increase in blood flow measured by audible Doppler signals in all patients after the arterial and venous anastamoses. There were no cases of partial or complete flap loss. One patient had a hematoma and subsequently developed minor fat necrosis. One patient had an infection of the reconstructed breast. There were no donor site complications.
Supercharging the TRAM flap by means of microvascular augmentation of the deep inferior epigastric vessels provides a safe and effective breast reconstruction in the overweight and obese population with no additional morbidity.
传统上，采用横行腹直肌肌皮瓣（TRAM瓣）进行自体乳房重建是基于腹壁上血管（带蒂）或腹壁下深血管系统（游离）。在超重和肥胖人群中，这两种技术均已显示出重建乳房的并发症增多。另一种选择是通过将腹壁下深血管与胸廓内血管或胸背血管吻合来增强皮瓣血运。我们介绍了一位外科医生对超重和肥胖患者进行单侧TRAM重建并将其与胸背血管、胸廓内血管或在1例中与穿支血管进行血运增强的经验。
2000年11月至2004年11月期间，19例连续的超重或肥胖患者接受了延迟或即刻的单侧自体乳房重建，采用血运增强的TRAM瓣。患者年龄在28至66岁之间（平均49岁），平均体重指数（BMI）为29.5（24.9 - 38.3）。12例患者的BMI在25至29.9 kg/m²之间；7例患者的BMI≥30 kg/m²。左侧重建13例；右侧重建6例。通过将腹壁下深动脉和静脉与胸背血管、胸廓内血管或穿支血管吻合来实现血运增强。
随访时间为6至54个月。在动脉和静脉吻合后，通过可闻及的多普勒信号测量，所有患者的血流均有定性增加。没有出现皮瓣部分或完全坏死的病例。1例患者出现血肿，随后发生轻微脂肪坏死。1例患者的重建乳房发生感染。没有供区并发症。
通过对腹壁下深血管进行微血管增强来增强TRAM瓣血运，可为超重和肥胖人群提供安全有效的乳房重建，且无额外的发病率。
