Lee Won Seob, Park Seong Oh, Kim Il-Kug
Department of Plastic and Reconstructive Surgery, Yeungnam University College of Medicine, Daegu 42415, Korea.
Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul 04763, Korea.
J Clin Med. 2022 Mar 30;11(7):1929. doi: 10.3390/jcm11071929.
While the transverse rectus abdominis myocutaneous (TRAM) flap is a popular option for abdominal-based breast reconstruction, abdominal wall morbidities such as bulging or hernia remain a concern. Here, we introduced a surgical technique for reinforcing the abdominal wall using an onlay autograft obtained from discarded zone IV tissue following a primary closure. We compared abdominal wall morbidities between patients receiving an onlay graft and those receiving primary closure only. We retrospectively reviewed the medical charts of patients who underwent breast reconstruction using a TRAM flap between December 2018 and May 2021. Additionally, we assessed donor-site morbidities based on physical examination. Of the 79 patients included, 38 had received a dermal graft and 41 had not. Donor-site morbidities occurred in 10 (24.5%) and 1 (2.6%) patients, and bulging occurred in 8 (19.5%) and 1 (2.6%) patients in the primary closure and dermal autograft groups, respectively. A statistically significant difference in the incidence of bulging was observed between the groups ( = 0.030). In conclusion, the introduction of a dermal autograft after primary closure can successfully ameliorate morbidities at the TRAM flap site.
虽然腹直肌横形肌皮瓣（TRAM瓣）是基于腹部的乳房重建的常用选择，但腹壁并发症如膨出或疝气仍然令人担忧。在此，我们介绍了一种手术技术，即在一期缝合后使用取自废弃IV区组织的覆盖自体移植物来加强腹壁。我们比较了接受覆盖移植物的患者与仅接受一期缝合的患者之间的腹壁并发症情况。我们回顾性地查阅了2018年12月至2021年5月期间接受TRAM瓣乳房重建的患者的病历。此外，我们通过体格检查评估供区并发症。在纳入的79例患者中，38例接受了真皮移植，41例未接受。供区并发症分别发生在一期缝合组的10例（24.5%）和真皮自体移植组的1例（2.6%）患者中，膨出分别发生在一期缝合组的8例（19.5%）和真皮自体移植组的1例（2.6%）患者中。两组之间膨出发生率的差异具有统计学意义（ = 0.030）。总之，一期缝合后引入真皮自体移植可以成功改善TRAM瓣部位的并发症。
