Bando M, Tanaka S
Dept. of Reconstructive Plastic Surgery, Tokyo Metropolitan Komagome Hospital.
Gan To Kagaku Ryoho. 1994 Jun;21 Suppl 2:249-54.
Since 1982, there have been many outstanding reports by Hartrampf, Dinner and others about the TRAM (transverse rectus abdominis m- c) flap. This procedure is now recognized as one of the best reconstructive armamentarium. Authors also have performed reconstruction by this flap over the past 13 years for 150 cases of chest wall defects and breast deformities with very good results. Through these experiences and studies in cadaver dissection, the authors are convinced that the blood supply of TRAM flap is enough with medial approximately 3/5 muscle as a pedicle, and the lateral 2/5 part of muscle can be preserved with the intercostal nerve innervation intact. The weak point of the TRAM flap is the unstable blood supply of the contralateral portion of skin island (Hartrampf's zone 4). Thus, the authors have been making the flaps with double narrowed pedicle, in cases where a large amount of tissue graft is indispensable. We have performed these refined TRAM flap procedures in 44 cases from 1990. Among the numerous advantages, for example, is the fact that synthetic material is never required to obtain a stable abdominal wall, and TRAM x 2 type flaps are very useful, especially in cases with scars in the lower abdomen that were previously thought to be contraindications for TRAM flap. No disadvantage was observed in these refined TRAM flap procedures.
自1982年以来，哈特兰普夫、迪纳等人发表了许多关于横行腹直肌肌皮瓣（TRAM瓣）的杰出报告。该手术现已被公认为最佳重建手段之一。在过去13年里，作者也采用此皮瓣对150例胸壁缺损和乳房畸形进行了重建，效果非常好。通过这些经验以及尸体解剖研究，作者确信，以内侧约五分之三的肌肉为蒂，TRAM皮瓣的血供充足，外侧五分之二的肌肉部分可在肋间神经支配完整的情况下予以保留。TRAM皮瓣的弱点在于皮岛对侧部分（哈特兰普夫4区）血供不稳定。因此，在大量组织移植必不可少的情况下，作者一直制作双蒂变窄皮瓣。自1990年以来，我们已对44例患者实施了这些改良的TRAM皮瓣手术。在众多优点中，例如，无需使用合成材料就能获得稳定的腹壁，而且双TRAM皮瓣非常有用，尤其是在下腹部有瘢痕的病例中，这类病例以前被认为是TRAM皮瓣的禁忌证。在这些改良的TRAM皮瓣手术中未观察到任何缺点。
