Department of Plastic and Reconstructive Surgery, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey.
Private Practice, İstanbul, Turkey.
Turk J Med Sci. 2017 Jun 12;47(3):861-867. doi: 10.3906/sag-1603-47.
BACKGROUND/AIM: The pedicled transverse rectus abdominis myocutaneous (TRAM) flap remains widely used as a breast reconstruction technique. The bipedicled TRAM flap is not as preferable as it was formerly, mainly because of its donor site complications. However, in a number of situations, a bipedicled TRAM flap may be the only alternative. Therefore, a three-layer primary closure technique used with bipedicled TRAM flap breast reconstructions that can avoid donor site complications without using a mesh is presented.
A retrospective study was performed that included patients who underwent bipedicled TRAM flap breast reconstruction with the three-layer primary closure technique. Between 2000 and 2015, 124 breast reconstruction patients were reviewed for donor site morbidity.
During the 15-year study period, 106 patients had conventional bipedicled TRAM flaps and 18 had bipedicled TRAM flaps with a surgical delay procedure. For all groups, none of the patients developed abdominal wall hernia, but three patients had bulging. Partial flap loss was the most common flap complication, present in 6 flaps (4.8%).
The suturing technique studied provided abdominal wall closure without the use of a mesh even when utilizing a bilateral pedicle with very low complication rates.
背景/目的：带蒂腹直肌肌皮瓣（TRAM）仍然被广泛用作乳房重建技术。双蒂 TRAM 皮瓣不如以前受欢迎，主要是因为其供区并发症。然而，在许多情况下，双蒂 TRAM 皮瓣可能是唯一的选择。因此，提出了一种用于双蒂 TRAM 皮瓣乳房重建的三层原发性闭合技术，该技术可避免供区并发症，而无需使用网片。
对接受三层原发性闭合技术的双蒂 TRAM 皮瓣乳房重建的患者进行回顾性研究。在 2000 年至 2015 年间，对 124 例乳房重建患者的供区发病率进行了回顾。
在 15 年的研究期间，106 例患者接受了常规双蒂 TRAM 皮瓣，18 例患者接受了带手术延迟的双蒂 TRAM 皮瓣。对于所有组，没有患者发生腹壁疝，但有 3 例患者出现膨出。部分皮瓣坏死是最常见的皮瓣并发症，存在于 6 例皮瓣中（4.8%）。
所研究的缝合技术提供了腹壁闭合，即使使用双侧蒂也无需使用网片，且并发症发生率非常低。
