Israeli Ron, Hazani Ron, Feingold Randall S, DeNoto George, Scheiner Marc S
Aesthetic Plastic Surgery, PC, Great Neck, NY 11021, USA.
Ann Plast Surg. 2009 Dec;63(6):654-8. doi: 10.1097/SAP.0b013e31819ae08e.
Many patients undergoing reconstructive surgery after mastectomy opt for reconstruction with the transverse rectus abdominis myocutaneous (TRAM) flap. Among the morbidities related to TRAM flap reconstruction is the development of abdominal wall contour abnormalities, including bulges or hernias. Several repair techniques at the flap abdominal wall donor site have been described for use at the time of flap harvest in an attempt to reduce the risk of such abdominal wall complications. For patients that develop abdominal wall contour abnormalities, numerous reconstructive options have been reported, with mixed results. Ten patients were identified as having abdominal wall contour abnormalities after a TRAM flap and underwent an extended mesh repair with external oblique muscle reinforcement. The mesh was secured to the bony landmarks of the lower abdomen and the abdominal wall fascia. All patients achieved complete resolution of abdominal wall bulging. In the follow-up period, no recurrences, infections, or seromas were noted. One patient, who failed an earlier repair at the inferior abdominal wall, reported symptoms consistent with a scar neuroma. Symptoms were treated successfully with gabapentin and a nonsteroidal anti-inflammatory drug. We propose a novel and reliable method of lower abdominal wall reconstruction for patients with post-TRAM flap abdominal wall contour abnormalities. This technique incorporates the use of a large Marlex mesh reinforced with bilateral external oblique muscle flaps. We report a series of 10 patients who have achieved resolution of their symptoms and have regained a natural, flat-appearing abdominal wall contour.
许多接受乳房切除术后重建手术的患者选择采用腹直肌横形肌皮瓣（TRAM瓣）进行重建。与TRAM瓣重建相关的并发症包括腹壁轮廓异常，如凸起或疝气。为了降低此类腹壁并发症的风险，在切取皮瓣时已描述了几种在皮瓣腹壁供区的修复技术。对于出现腹壁轮廓异常的患者，已有多种重建选择的报道，但结果不一。10例患者在接受TRAM瓣手术后被确定存在腹壁轮廓异常，并接受了带腹外斜肌加强的扩大补片修补术。补片固定于下腹部的骨性标志和腹壁筋膜上。所有患者的腹壁凸起均完全消失。在随访期间，未发现复发、感染或血清肿。1例曾在下腹壁修补失败的患者报告有与瘢痕神经瘤相符的症状。使用加巴喷丁和一种非甾体抗炎药成功治疗了症状。我们提出一种针对TRAM瓣术后腹壁轮廓异常患者的新颖且可靠的下腹壁重建方法。该技术采用了用双侧腹外斜肌瓣加强的大型Marlex补片。我们报告了一组10例患者，他们的症状已得到缓解，腹壁轮廓恢复自然、平整。
