Salzburg, Austria; and Stuttgart, Germany From the Departments of Plastic and Reconstructive Surgery of Paracelsus Medical University and Marienhospital Stuttgart.
Plast Reconstr Surg. 2011 Oct;128(4):233e-242e. doi: 10.1097/PRS.0b013e3182268a99.
The authors have used the transverse musculocutaneous gracilis flap technique for autologous breast reconstruction after skin-sparing mastectomy since August of 2002. The donor site is closed in the manner of a medial thigh lift. The authors examined the short-term and long-term results of donor-site morbidity in their first 22 patients.
Nineteen patients underwent unilateral and three patients received bilateral breast reconstruction with a transverse musculocutaneous gracilis flap after skin-sparing mastectomy. Using a questionnaire, patients were asked about complaints resulting from elevation of the gracilis muscle and their satisfaction with the result, general condition, and sexuality. Cosmetic evaluations of the thigh donor site were performed independently by two plastic surgeons.
To evaluate short-term results, mean follow-up of the 22 patients was 10 months. All patients were satisfied with the scar in the inguinal region. Concerning thigh symmetry, 42 percent of patients showed excellent results, 40 percent had good results, and 18 percent had fair results. With regard to the scars, 24 percent of patients had excellent results, 46 percent had good results, and 30 percent had fair results. Thigh shape was evaluated as excellent by 26 percent, good by 52 percent, and fair by 22 percent. Patients who had a unilateral gracilis donor site had a difference in maximal thigh circumference of 2.368 cm. Four years postoperatively, all patients would choose this kind of operation again.
The medial thigh region allows the removal of a moderate amount of tissue, even in thin patients, with a very inconspicuous scar. The transverse musculocutaneous gracilis flap is safe for immediate reconstruction of small and medium-sized breasts, with minimal functional donor-site morbidity.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
自 2002 年 8 月以来，作者一直使用横形肌皮骨髂肌皮瓣技术进行保留皮肤的乳房切除术的自体乳房重建。供区以股内侧提升的方式关闭。作者检查了他们前 22 位患者供区发病率的短期和长期结果。
19 例患者在保留皮肤的乳房切除术后接受单侧乳房重建，3 例患者接受双侧乳房重建，采用横形肌皮骨髂肌皮瓣。使用问卷，患者被询问关于提升骼腰肌引起的抱怨以及对结果、一般状况和性生活的满意度。两位整形外科医生独立对大腿供区的美容评估进行了评估。
为了评估短期结果，22 例患者的平均随访时间为 10 个月。所有患者对腹股沟区的疤痕均满意。关于大腿对称性，42%的患者结果优秀，40%的患者结果良好，18%的患者结果一般。至于疤痕，24%的患者结果优秀，46%的患者结果良好，30%的患者结果一般。大腿形状评估为优秀的占 26%，良好的占 52%，一般的占 22%。单侧骼腰肌供区的患者大腿最大周长相差 2.368cm。术后 4 年，所有患者均会再次选择这种手术。
大腿内侧区域允许去除适量的组织，即使是在很瘦的患者中，也只有一条非常不显眼的疤痕。横形肌皮骨髂肌皮瓣用于即刻重建小、中型乳房是安全的，供区功能发病率低。
临床问题/证据水平：治疗性，IV。
