Freiburg, Germany; and Palo Alto, Calif. From the Department of Plastic and Hand Surgery, University of Freiburg Medical Center, and Division of Plastic and Reconstructive Surgery and Department of Surgery, Stanford University Medical Center.
Plast Reconstr Surg. 2010 Nov;126(5):1454-1459. doi: 10.1097/PRS.0b013e3181ef904b.
Microsurgical autologous breast reconstruction has evolved significantly over the last three decades. The muscle-sparing transverse rectus abdominis musculocutaneous (TRAM), deep inferior epigastric artery perforator, and superficial inferior epigastric artery flaps have been developed to minimize abdominal donor-site morbidity. Assuming that harvest of the superficial inferior epigastric artery flap has the same impact on abdominal wall morbidity as performing an abdominoplasty, the authors designed a matched-pair analysis comparing patients' abdominal wall strength after muscle-sparing TRAM flap reconstruction with that after abdominoplasty.
A total of 104 patients were included in the study. Fifty-two TRAM flap patients were matched with 52 abdominoplasty patients for age and body mass index. Outcome measures included postoperative complications, particularly hernia and abdominal bulge formation. Two surveys were used to assess patient satisfaction as well as the impact of the procedure on everyday life.
Both study groups were similar with regard to age, body mass index, past medical history, and postoperative complication rate, including hernia and abdominal bulge formation. Results were similar between the study groups, with the exception of a higher rate of satisfaction with the appearance of the abdominal scar among TRAM flap patients (p=0.03) as well a lower likelihood of TRAM flap patients to engaging in sporting activities postoperatively (p=0.01).
In the present study, the muscle-sparing TRAM flap did not result in a higher rate of postoperative complications related to abdominal wall morbidity. Differences observed regarding the postoperative level of activity are unlikely to be related to the surgical insult to the abdominal wall.
显微自体乳房重建在过去三十年中发生了重大变化。为了最大限度地减少腹部供区的发病率，开发了保留肌肉的横形腹直肌肌皮瓣（TRAM）、腹壁下动脉穿支皮瓣和腹壁浅动脉皮瓣。假设腹壁浅动脉皮瓣的采集对腹壁发病率的影响与进行腹部整形术相同，作者设计了一项配对分析，比较了保留肌肉的 TRAM 皮瓣重建后和腹部整形术后患者腹壁强度。
共有 104 例患者纳入本研究。52 例 TRAM 皮瓣患者与 52 例腹部整形患者按年龄和体重指数匹配。结果测量包括术后并发症，特别是疝和腹部膨出的形成。使用两项调查评估患者满意度以及该手术对日常生活的影响。
两组患者在年龄、体重指数、既往病史和术后并发症发生率（包括疝和腹部膨出）方面相似。两组患者的结果相似，但 TRAM 皮瓣患者对腹部疤痕外观的满意度较高（p=0.03），以及术后 TRAM 皮瓣患者更有可能从事体育活动（p=0.01）。
在本研究中，保留肌肉的 TRAM 皮瓣不会导致与腹壁发病率相关的术后并发症发生率更高。观察到的术后活动水平的差异不太可能与对腹壁的手术损伤有关。
