Schirmer S, Warnecke I C, Frerichs O, Cervelli A, Fansa H
Klinik für Plastische, Rekonstruktive und Asthetische Chirurgie, Handchirurgie, Städtische Kliniken Bielefeld Mitte.
Handchir Mikrochir Plast Chir. 2008 Aug;40(4):262-6. doi: 10.1055/s-2008-1038857. Epub 2008 Aug 20.
While free TRAM or DIEP flaps are still the most common techniques for autologous breast reconstruction, there are also other flaps which are suitable for patients who are not candidates for a TRAM/DIEP flap. In addition to the S-GAP or I-GAP, the transverse myocutaneous gracilis (TMG) flap is an excellent alternative. The tissue utilised is taken from the medial thigh and inferior gluteal area. PATIENTS AND OPERATIONS: We have performed 37 TMG flap operations on 23 patients since 2007. The indications were breast cancer, asymmetry of the breasts and capsular fibrosis. The average age of our patients was 47 years. Incisions are similar to those of a transverse thigh lift. The flap is nourished by perforators from the gracilis and its proximal dominant pedicle. The landmark ventrally is the greater saphenous vein and midpoint of the inferior gluteal fold on the dorsal side. Its size can go up to 30 x 10 cm. Recipient vessels are the internal thoracic vessels. The donor site is closed primarily. All of our patients are immobilised for 2 days and were instructed to avoid sitting for 2 weeks.
12 patients were reconstructed after breast cancer, 8 patients had a capsular fibrosis and 3 patients had an asymmetry. The follow-up period was 8 months. Mean operating time for unilateral reconstruction is 220 minutes, for bilateral reconstruction 325 minutes. The weight of the flaps varied from 220 to 440 grams. It takes approximately 30 minutes to harvest the flap. There was no flap loss. Some of the patients described a tight feeling on the thighs for 3 weeks. They described a hypaesthesia on the dorsal thighs. There was one delayed wound healing caused by haematoma.
In our department, the TMG has become the most preferred flap for breast reconstruction besides the TRAM/DIEP. Especially slim patients with small breasts or a history of surgery on the abdominal wall are ideal candidates. The tissue from the medial thigh is very similar to the breast tissue. The constant vascular anatomy makes it easy to harvest the flap. The resulting scar is well hidden in the patients' underwear.
虽然游离腹直肌肌皮瓣（TRAM）或腹壁下动脉穿支皮瓣（DIEP）仍然是自体乳房重建最常用的技术，但也有其他皮瓣适用于不适合TRAM/DIEP皮瓣的患者。除了臀上动脉穿支皮瓣（S-GAP）或臀下动脉穿支皮瓣（I-GAP）外，股薄肌横形肌皮瓣（TMG）也是一种很好的选择。所利用的组织取自大腿内侧和臀下区域。
自2007年以来，我们对23例患者进行了37例TMG皮瓣手术。适应症为乳腺癌、乳房不对称和包膜纤维化。我们患者的平均年龄为47岁。切口与大腿横断提升术的切口相似。皮瓣由股薄肌的穿支及其近端优势蒂供血。腹侧的标志是大隐静脉，背侧是臀下皱襞的中点。其大小可达30×10厘米。受区血管为胸廓内血管。供区主要直接缝合。我们所有的患者均固定2天，并被指示避免坐2周。
12例患者在乳腺癌后进行了重建，8例患者有包膜纤维化，3例患者有乳房不对称。随访期为8个月。单侧重建的平均手术时间为220分钟，双侧重建为325分钟。皮瓣重量在220至440克之间。切取皮瓣大约需要30分钟。没有皮瓣坏死。一些患者描述大腿有3周的紧绷感。他们描述大腿背侧有感觉减退。有1例因血肿导致伤口愈合延迟。
在我们科室，TMG已成为除TRAM/DIEP之外乳房重建最常用的皮瓣。特别是乳房较小或有腹壁手术史的苗条患者是理想的候选者。大腿内侧的组织与乳房组织非常相似。恒定的血管解剖结构使其易于切取皮瓣。产生的瘢痕很好地隐藏在患者的内衣内。
