Boston, Mass. From the Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, and the Division of Plastic Surgery, Department of Surgery, Beth Israel Deaconess Medical Center.
Plast Reconstr Surg. 2010 Oct;126(4):1133-1141. doi: 10.1097/PRS.0b013e3181ea42d3.
The potential for donor-site morbidity associated with bilateral pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction has led to the popularization of deep inferior epigastric artery perforator (DIEP) flap reconstruction. This study compares postoperative morbidity and satisfaction following bilateral pedicled TRAM and DIEP flap reconstruction.
One hundred five women with bilateral pedicled TRAM flaps were compared with 58 women with bilateral DIEP flap reconstruction. Medical records were reviewed for complications and demographic data. Postoperative follow-up data were obtained through Short Form-36, Functional Assessment of Cancer Therapy-Breast, Michigan Breast Satisfaction, and Qualitative Assessment of Back Pain surveys.
The mean follow-up interval was 6.2 years in the bilateral TRAM group and 2.3 years in the bilateral DIEP group (p < 0.001). Demographic data were otherwise similar. Abdominal hernias occurred in three TRAM patients (2.9 percent) and in no DIEP patients, whereas abdominal bulges occurred in three TRAM patients (2.9 percent) and four DIEP patients (6.9 percent); these differences were not statistically significant. Fat necrosis occurred less frequently in the TRAM group (p = 0.04). Postoperative survey results revealed no significant difference in patient satisfaction, incidence of back pain, or physical function. The TRAM group scored higher in the Medical Outcome Study Short Form-36 subjective energy category (p = 0.01) and mean Functional Assessment of Cancer Therapy-Breast score (p = 0.01).
This study suggests no significant differences in donor-site morbidity, survey-based functional outcome, or patient satisfaction between bilateral TRAM and DIEP flap breast reconstruction. Although perforator flaps represent an important technological advancement, bilateral pedicled TRAM flap reconstruction still represents a good option for autologous breast reconstruction.
双侧带蒂横行腹直肌肌皮瓣（TRAM）乳房再造相关供区并发症的潜在风险导致了深下腹动脉穿支（DIEP）皮瓣重建的普及。本研究比较了双侧带蒂 TRAM 与 DIEP 皮瓣重建术后的发病率和满意度。
将 105 例双侧带蒂 TRAM 皮瓣患者与 58 例双侧 DIEP 皮瓣重建患者进行比较。回顾性分析并发症和人口统计学数据。通过简明健康调查问卷（SF-36）、癌症治疗功能评估-乳房（FACT-B）、密歇根乳房满意度和背部疼痛定性评估调查获得术后随访数据。
双侧 TRAM 组的平均随访时间为 6.2 年，双侧 DIEP 组为 2.3 年（p＜0.001）。两组的人口统计学数据相似。TRAM 组中有 3 例（2.9%）患者发生腹壁疝，而 DIEP 组无患者发生；TRAM 组中有 3 例（2.9%）患者发生腹壁膨出，DIEP 组有 4 例（6.9%）患者发生；但这些差异无统计学意义。TRAM 组的脂肪坏死发生率较低（p=0.04）。术后调查结果显示，两组患者的满意度、背痛发生率或身体功能均无显著差异。TRAM 组在简明健康调查问卷（SF-36）主观能量类别（p=0.01）和癌症治疗功能评估-乳房（FACT-B）平均得分（p=0.01）上的评分更高。
本研究表明，双侧 TRAM 与 DIEP 皮瓣乳房再造在供区并发症、基于调查的功能结果或患者满意度方面无显著差异。虽然穿支皮瓣代表了一项重要的技术进步，但双侧带蒂 TRAM 皮瓣重建仍然是自体乳房再造的一个不错的选择。
