Dallas, Texas; and Lyon, France From the University of Texas Southwestern Medical Center and the Department of Plastic Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, University of Lyon.
Plast Reconstr Surg. 2012 Jan;129(1):24e-36e. doi: 10.1097/PRS.0b013e31823620cb.
The transverse myocutaneous gracilis flap has traditionally been used to reconstruct smaller breasts. The authors have been performing autologous breast reconstruction utilizing the flap with two types of modifications to increase flap volume: an extended and a vertical extended flap. In this article, they discuss the different operative techniques and present a clinical series of both flap types.
A retrospective review of all patients undergoing either flap modification under the senior author (M.S.-C.) was performed. Data collated included pedicle artery and vein diameters, flap weight, and patient complications.
Twenty-four transverse myocutaneous gracilis flaps were performed: 12 extended (seven patients) and 12 vertical flaps (six patients). The vertical group trended to have greater flap weights than the extended group. Mean flap weight was 385.75 g (range, 181 to 750 g) for the extended group and 469.75 g (range, 380 to 605 g) for the vertical group (p = 0.06). Mean arterial diameter of the medial circumflex artery was 1.9 mm (range, 1.5 to 2.0 mm), mean venous diameter was 2.4 mm (range, 2.0 to 3.5 mm), and mean pedicle length was 6.8 cm (range, 6.0 to 7.0 cm). All donor sites were closed primarily. Complications included seroma (n = 1), wound dehiscence (n = 2), and partial flap loss (n = 2).
Modifications of the transverse myocutaneous gracilis flap increase flap volume and can be useful in patients who do not wish to have abdomen, buttock, or back scars. Donor-site scars can be concealed, and patients have the added benefit of a thigh lift. Complications are comparable to those found with other reconstructive options.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
横形肌皮瓣传统上用于重建较小的乳房。作者一直在利用该皮瓣进行自体乳房重建，采用两种类型的改良来增加皮瓣体积：扩展皮瓣和垂直扩展皮瓣。本文讨论了不同的手术技术，并介绍了这两种皮瓣类型的临床系列。
对所有在资深作者（M.S.-C.）下行皮瓣改良的患者进行回顾性研究。收集的数据包括蒂动脉和静脉的直径、皮瓣重量和患者并发症。
共完成 24 例横形肌皮瓣：12 例扩展皮瓣（7 例）和 12 例垂直皮瓣（6 例）。垂直组皮瓣重量趋势大于扩展组。扩展组皮瓣平均重量为 385.75g（范围 181750g），垂直组为 469.75g（范围 380605g）（p=0.06）。旋股内侧动脉的平均动脉直径为 1.9mm（范围 1.52.0mm），平均静脉直径为 2.4mm（范围 2.03.5mm），蒂长平均为 6.8cm（范围 6.0~7.0cm）。所有供区均一期闭合。并发症包括血清肿（n=1）、伤口裂开（n=2）和部分皮瓣坏死（n=2）。
横形肌皮瓣的改良增加了皮瓣的体积，对于那些不希望有腹部、臀部或背部疤痕的患者是有用的。供区疤痕可以被隐藏，并且患者还可以获得大腿提升的额外好处。并发症与其他重建方法相似。
临床问题/证据水平：治疗性，III 级。
