Rossetto Luis Antonio, Abla Luiz Eduardo Felipe, Vidal Ronaldo, Garcia Elvio Bueno, Gonzalez Ricardo João, Gebrim Luiz Henrique, Neto Miguel Sabino, Ferreira Lydia Masako
Eur J Plast Surg. 2010 Aug;33(4):203-208. doi: 10.1007/s00238-010-0418-4. Epub 2010 Apr 7.
The purpose of this study was to evaluate the correlation between risk factors and hernia or bulge formation at the donor site of the transverse rectus abdominis myocutaneous (TRAM) flap. A retrospective study was conducted between September 2005 and December 2008 in 206 patients who underwent breast reconstruction with pedicled TRAM flap. Eight (3.9%) of these patients had abdominal wall hernia and 26 (12.6%) had abdominal bulging. The incidence of hernia was significantly higher (P < 0.05) among patients with body mass index (BMI) >/= 30 kg/m(2) (hernia incidence, 15.0%) than that among patients with BMI <30 kg/m(2) (hernia incidence, 3.2%), while the incidence of abdominal bulge was significantly lower (P < 0.05) among patients with BMI >/= 30 kg/m(2) (abdominal bulge incidence, 5.0%) than that among patients with BMI >/= 30 kg/m(2) (abdominal bulge incidence, 19.1%). Therefore, obesity was identified as a risk factor for abdominal wall hernia. It was also found that the use of mesh to reinforce the abdominal wall significantly reduced (P < 0.025) the incidence of hernia (use of mesh (hernia incidence, 2.5%) versus non-mesh (hernia incidence, 5.9%)) and abdominal bulge (use of mesh (abdominal bulge incidence, 9.9%) versus non-mesh (abdominal bulge incidence, 17.3%)) among the patients.
本研究的目的是评估腹直肌肌皮瓣（TRAM瓣）供区危险因素与疝或膨出形成之间的相关性。2005年9月至2008年12月，对206例行带蒂TRAM瓣乳房重建术的患者进行了一项回顾性研究。其中8例（3.9%）发生腹壁疝，26例（12.6%）出现腹部膨出。体重指数（BMI）≥30kg/m²的患者疝发生率（15.0%）显著高于BMI<30kg/m²的患者（疝发生率3.2%）（P<0.05），而BMI≥30kg/m²的患者腹部膨出发生率（5.0%）显著低于BMI<30kg/m²的患者（腹部膨出发生率19.1%）（P<0.05）。因此，肥胖被确定为腹壁疝的一个危险因素。还发现，使用补片加强腹壁可显著降低患者的疝发生率（使用补片（疝发生率2.5%）与未使用补片（疝发生率5.9%））和腹部膨出发生率（使用补片（腹部膨出发生率9.9%）与未使用补片（腹部膨出发生率17.3%））（P<0.025）。
