Codner M A, Bostwick J, Nahai F, Bried J T, Eaves F F
Section of Plastic, Reconstructive and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA., USA.
Plast Reconstr Surg. 1995 Dec;96(7):1615-22. doi: 10.1097/00006534-199512000-00015.
The purpose of this study was to evaluate the intraoperative changes in physiologic blood pressure following vascular delay of the TRAM flap. Ligation of the superficial and deep inferior epigastric vessels 2 weeks prior to the TRAM flap was performed. The incidence of fat necrosis was 4.3 percent in 23 high-risk patients who underwent 30 immediate breast reconstructions. Direct measurement of blood pressure in the deep inferior epigastric artery and vein was performed in a control group without delay consisting of 13 low-risk patients and in the study group of 7 high-risk patients who underwent vascular delay. Changes in TRAM flap perfusion pressure were examined following the change in location of the flap from the abdomen to the chest. Blood pressure measurements demonstrated that arterial pressure in the proximal stump of the deep inferior epigastric artery was 64 percent in the study group prior to delay and 72 percent in the control group. The physiologic response to vascular delay included an overall increase in arterial pressure with a decrease in venous congestion. TRAM flap perfusion pressure was significantly increased from 13.3 mmHg (control) to 40.3 mmHg (delayed) in the region of the midrectus perforators (p < 0.05). These data suggest that the technique of TRAM flap delay may increase the reliable tissue volume and improve the safety of the TRAM flap.
本研究的目的是评估横行腹直肌肌皮瓣（TRAM瓣）血管延迟术中生理血压的变化。在TRAM瓣手术前2周结扎腹壁下浅静脉和深静脉。在接受30次即刻乳房重建的23例高危患者中，脂肪坏死发生率为4.3%。在由13例低危患者组成的无延迟对照组以及7例接受血管延迟的高危患者研究组中，对腹壁下深动脉和静脉进行了血压直接测量。在TRAM瓣从腹部转移至胸部后，检查了TRAM瓣灌注压力的变化。血压测量结果显示，研究组延迟前腹壁下深动脉近端残端的动脉压为64%，对照组为72%。血管延迟的生理反应包括动脉压总体升高以及静脉淤血减轻。在腹直肌中穿支区域，TRAM瓣灌注压力从13.3 mmHg（对照组）显著升高至40.3 mmHg（延迟组）（p < 0.05）。这些数据表明，TRAM瓣延迟技术可能会增加可靠的组织体积并提高TRAM瓣的安全性。
