Zienowicz R J, May J W
Division of Plastic Surgery, Massachusetts General Hospital, Boston, USA.
Plast Reconstr Surg. 1995 Nov;96(6):1346-50. doi: 10.1097/00006534-199511000-00017.
The value of synthetic mesh use in the treatment of recurrent abdominal hernias is well recognized and has led to its advocacy by some authors as an adjunct in primary hernia repair. Mesh use in the donor-site closure associated with TRAM flap reconstruction is typically restricted to situations where undue tension or questionable tissue integrity may be predisposing factors to herniation. Although more liberal use of mesh has been advocated for these circumstances, fear of mesh complications may continue to restrict its use. We present a series of 65 consecutive patients who had routine mesh application to fascial closures following TRAM flap breast reconstruction. The use of mesh provides an added margin of strength to fascial reconstruction and was found to have additional benefit as a technical adjunct to the aesthetic aspects of the abdominoplasty. Mean patient follow-up was 56.4 months. The resulting rates of hernia (1.5 percent) and mesh-related infection (1.5 percent) demonstrate its considerable safety. We recommend consideration of polypropylene mesh use for improved strength and aesthetic quality of the donor-site closure following TRAM flap breast reconstruction.
合成补片在复发性腹疝治疗中的价值已得到充分认可，一些作者主张将其作为原发性疝修补的辅助手段。与横行腹直肌肌皮瓣（TRAM瓣）重建相关的供区关闭中使用补片通常限于存在过度张力或可疑组织完整性可能是疝形成的易感因素的情况。尽管有人主张在这些情况下更广泛地使用补片，但对补片并发症的担忧可能继续限制其使用。我们报告了连续65例患者，他们在TRAM瓣乳房重建后对筋膜关闭常规应用了补片。补片的使用为筋膜重建增加了强度余量，并且发现作为腹壁成形术美学方面的技术辅助手段还有额外益处。患者平均随访时间为56.4个月。由此产生的疝发生率（1.5%）和补片相关感染率（1.5%）证明了其相当高的安全性。我们建议考虑使用聚丙烯补片以提高TRAM瓣乳房重建后供区关闭的强度和美学质量。
