Kim Yumin, Kim Ji-Young, Chang Hak
Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Republic of Korea.
J Plast Surg Hand Surg. 2025 Mar 19;60:67-70. doi: 10.2340/jphs.v60.42961.
Muscle sparing-transverse rectus abdominis flap has been widely used for breast reconstruction and the abdominal hernia or bulging at the donor site is relatively common complication. Previous studies have emphasized the fascial defects and the defect of muscle has been neglected. This study aims to investigate the relationship between the size of the rectus abdominis muscle defect and its impact on hernia or bulge formation after muscle sparing-transverse rectus abdominis flap.
A retrospective study of patients undergoing unilateral or bilateral breast reconstruction with muscle sparing-transverse rectus abdominis myocutaneous flap was performed. We compared the patient group with postoperative abdominal hernia or bulging requiring surgery with the patient group without hernia. The surgical specific data of the size of rectus abdominis muscle defect, muscle sparing type and flap weight are analyzed. Results: We conducted a survey on a total of 160 patients, of which six patients experienced abdominal hernia or bulging requiring surgery. Comparing patient group requiring surgical treatment for hernia or bulging with patient group without hernia, there was a significant difference of the width of rectus abdominis muscle defect. The cut-off value of the width was 4.5 cm. Conclusion: When performing MS-TRAM, minimizing the resection of rectus abdominis muscle remains crucial, especially the horizontal width.
保留肌肉的腹直肌肌皮瓣已广泛用于乳房重建，供区的腹壁疝或膨出是相对常见的并发症。以往研究多强调筋膜缺损，而肌肉缺损常被忽视。本研究旨在探讨保留肌肉的腹直肌肌皮瓣术后腹直肌肌肉缺损大小与疝或膨出形成之间的关系。
对接受单侧或双侧保留肌肉的腹直肌肌皮瓣乳房重建的患者进行回顾性研究。我们将术后发生腹壁疝或膨出且需要手术治疗的患者组与未发生疝的患者组进行比较。分析腹直肌肌肉缺损大小、保留肌肉类型及皮瓣重量等手术相关具体数据。
共纳入160例患者，其中6例发生腹壁疝或膨出且需要手术治疗。将需要手术治疗疝或膨出的患者组与未发生疝的患者组进行比较，腹直肌肌肉缺损宽度存在显著差异。宽度的临界值为4.5 cm。
在进行保留肌肉的腹直肌肌皮瓣手术时，尽量减少腹直肌的切除仍然至关重要，尤其是水平宽度。
