Pamplona, Spain From the Departments of Plastic and Reconstructive Surgery and Gynecology and Obstetrics, Clínica Universidad de Navarra.
Plast Reconstr Surg. 2013 Dec;132(6):1020e-1027e. doi: 10.1097/PRS.0b013e3182a97ea2.
The purpose of this study was to compare the transverse rectus abdominis myocutaneous (TRAM) pedicled flap with a muscle and fascia-sparing flap based on the deep inferior epigastric perforator (DIEP) in total vaginal reconstruction. The authors studied the advantages and disadvantages of both flaps.
From January of 1986 to July of 2010, 75 patients who underwent pelvic exenteration for gynecologic cancer were retrospectively reviewed. Sixty-two patients had recurrent disease and 13 had primary tumors. Forty patients underwent vaginal reconstruction, 21 with TRAM flaps and seven with DIEP flaps. Flap survival, donor-site morbidity, neovagina stenosis, flap harvest time, and hospital stay were registered for both groups.
All DIEP flaps survived in all patients. In the TRAM group, however, three flaps were lost because of total necrosis and five presented partial necrosis. Mean harvest time was 63 minutes for the DIEP flap and 105 minutes for the TRAM flap. No abdominal wall complications occurred in the DIEP flap group, whereas four cases of donor-site morbidity were registered in the TRAM group, even though mesh was used in all cases. During follow-up examination, all patients had normal-appearing external genitalia.
The DIEP flap seems to be a promising flap for this kind of reconstruction and could replace the TRAM flap. The authors detected a decrease in donor-site abdominal morbidity when using the DIEP flap compared with the TRAM flap.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究旨在比较经阴部深下动脉穿支（DIEP）游离皮瓣与保留肌肉和筋膜的横行腹直肌肌皮瓣在全阴道重建中的优缺点。作者研究了这两种皮瓣的优缺点。
1986 年 1 月至 2010 年 7 月，回顾性分析了 75 例行盆腔廓清术治疗妇科恶性肿瘤的患者。62 例患者有复发病灶，13 例为原发性肿瘤。40 例行阴道重建术，其中 21 例行横行腹直肌肌皮瓣（TRAM），7 例行 DIEP 皮瓣。记录两组患者的皮瓣存活率、供区并发症、新阴道狭窄、皮瓣采集时间和住院时间。
所有 DIEP 皮瓣均在所有患者中存活。然而，TRAM 组中有 3 个皮瓣因完全坏死而丢失，5 个皮瓣出现部分坏死。DIEP 皮瓣的平均采集时间为 63 分钟，TRAM 皮瓣为 105 分钟。DIEP 皮瓣组无腹壁并发症，而 TRAM 皮瓣组有 4 例出现供区并发症，尽管所有病例均使用了网片。在随访检查中，所有患者的外生殖器外观正常。
DIEP 皮瓣似乎是一种很有前途的重建皮瓣，可以替代 TRAM 皮瓣。与 TRAM 皮瓣相比，作者发现使用 DIEP 皮瓣可降低供区腹部并发症的发生率。
临床问题/证据水平：治疗，IV。
