Department of Plastic and Reconstructive Surgery, Hanyang University Medical Center, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, Republic of Korea.
Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2020 Jun;73(6):1060-1067. doi: 10.1016/j.bjps.2020.01.010. Epub 2020 Jan 22.
The pedicled transverse rectus abdominis myocutaneous flap (TRAM) remains an effective and widely-used method for breast reconstruction despite well-documented donor-site morbidity. We present the island-type pedicled TRAM flap as a way to obtain better and more reliable outcomes in breast reconstruction.
A retrospective chart review of patients who underwent breast reconstruction with an island-type pedicled TRAM flap was performed. Patient demographics and complications were reviewed. In the island-type pedicled TRAM flap, we transversely resected the upper ipsilateral rectus muscle surrounding the origin of the superior epigastric vessels, preserving only a 1-cm muscle strip including the vascular pedicle to prevent epigastric bulging and inframammary fold (IMF) disruption. The flap was turned over into the ipsilateral breast pocket. The IMF was repaired except for the portion where the pedicle was placed.
From January 2013 to November 2017, 88 patients underwent surgery using the island-type pedicled TRAM flap. The etiology of the defect was breast cancer with mastectomy in 86 cases, and paraffinoma in two cases. Seventy-seven patients underwent unilateral reconstruction, and 11 patients underwent bilateral reconstruction. Minor fat necrosis occurred in eight cases. Mild inframammary or epigastric bulging was observed in five cases, and neither partial nor total flap necrosis was observed. The aesthetic outcome of the IMF was evaluated in 55 cases, and 53 cases received good overall scores.
Although the island-type pedicled TRAM flap is technically challenging because careful dissection and pedicle identification is required, it can provide more reliable and better aesthetic results without an increased risk of vascular compromise.
尽管带蒂横行腹直肌肌皮瓣（TRAM）已被证实存在供区并发症，但它仍是一种有效的、广泛应用的乳房重建方法。我们提出岛状带蒂 TRAM 皮瓣，旨在获得更好、更可靠的乳房重建效果。
回顾性分析了 88 例行岛状带蒂 TRAM 皮瓣乳房重建术患者的临床资料。分析患者的一般资料和并发症。在岛状带蒂 TRAM 皮瓣中，我们横向切除了上侧腹直肌，保留了 1cm 宽的肌带，包括血管蒂，以防止上腹膨隆和乳房下皱襞（IMF）破坏。皮瓣翻转至同侧乳房袋内。修复 IMF，仅在蒂部放置的部位保留部分 IMF。
2013 年 1 月至 2017 年 11 月，88 例患者接受了岛状带蒂 TRAM 皮瓣手术。其中 86 例为乳腺癌根治术后缺损，2 例为石蜡瘤。77 例患者接受了单侧重建，11 例患者接受了双侧重建。8 例发生轻微脂肪坏死。5 例出现轻度乳房下或上腹膨隆，无部分或全部皮瓣坏死。55 例对 IMF 的美学效果进行了评估，其中 53 例获得了良好的总体评分。
尽管岛状带蒂 TRAM 皮瓣技术难度较大，需要仔细解剖和识别蒂部，但它可以提供更可靠和更好的美学效果，而不会增加血管损伤的风险。
