Division of Plastic and Reconstructive Surgery, Emory University, Atlanta, Georgia.
Aesthet Surg J. 2014 Feb;34(2):264-71. doi: 10.1177/1090820X13517707. Epub 2013 Dec 17.
Incisional hernia can develop following breast reconstruction with abdominal tissue regardless of technique, and the management is often challenging.
The authors characterize hernias following transverse rectus abdominis musculocutaneous (TRAM) flap procedures and evaluate outcomes of different strategies for repair.
All patients who underwent repair of a TRAM-related hernia or bulge between 2003 and 2011 at a single institution were retrospectively reviewed. A minimum of 2 years' follow-up was required for inclusion in this series. Outcomes of different techniques for repair were compared and risk factors for hernia recurrence identified.
Forty-three patients underwent repair of a TRAM-related hernia or bulge, most often with mesh (74.4%, n=32). At a mean overall follow-up of 5.2 years, 9 patients (20.9%) developed recurrent hernia or bulge. Compared to primary suture closure, the use of mesh was protective against recurrence (odds ratio, 0.05; 95% confidence interval, 0.00-0.65; P=.02), with the best results observed with fascial closure and underlay mesh reinforcement.
Incisional hernia following TRAM flap breast reconstruction can be a challenging problem. Attention to surgical technique and the use of mesh minimize the risk of recurrence.
无论采用何种技术，乳房重建后都可能发生切口疝，其治疗往往具有挑战性。
作者对横行腹直肌肌皮瓣（TRAM）手术后发生的疝进行了特征描述，并评估了不同修复策略的结果。
回顾性分析了 2003 年至 2011 年期间在一家机构接受 TRAM 相关疝或膨出修复的所有患者。本系列研究纳入的患者必须有至少 2 年的随访。比较了不同修复技术的结果，并确定了疝复发的危险因素。
43 例患者接受了 TRAM 相关疝或膨出的修复，其中大多数患者（74.4%，n=32）采用了补片。总体平均随访 5.2 年后，9 例（20.9%）患者出现复发性疝或膨出。与初次缝合关闭相比，使用补片可降低复发风险（比值比，0.05；95%置信区间，0.00-0.65；P=.02），其中筋膜关闭和补片下置加强的效果最佳。
TRAM 皮瓣乳房重建后发生切口疝可能是一个具有挑战性的问题。关注手术技术和使用补片可最大程度降低复发风险。
