Mizgala C L, Hartrampf C R, Bennett G K
Division of Plastic Surgery, Ochsner Clinic, New Orleans, Louisiana.
Clin Plast Surg. 1994 Apr;21(2):255-72.
Through the years, many surgeons have considered the potential for weakness in the abdominal wall as a major drawback to the use of the pedicled TRAM flap. This article begins with a review of the surgical anatomy of the abdominal wall. It continues with a review of technical details; beginning with a method of partial rectus muscle and fascia harvest that respects the vascular anatomy, and followed by multilayered direct fascial closure in all patients with selective alloplastic mesh reinforcement as necessary. It is the authors' opinion that these methods optimize postoperative abdominal function, leaving a competent abdominal wall that does not deteriorate through time. Supportive data gained through a 13-year experience with 662 patients are presented.
多年来，许多外科医生认为腹壁薄弱的可能性是带蒂腹直肌肌皮瓣（TRAM瓣）应用的一个主要缺点。本文首先回顾腹壁的手术解剖结构。接着回顾技术细节；首先介绍一种尊重血管解剖结构的部分腹直肌和筋膜切取方法，然后对所有患者进行多层直接筋膜缝合，并根据需要选择性地使用异体网片加强。作者认为，这些方法可优化术后腹部功能，使腹壁功能良好，且不会随时间推移而恶化。本文还展示了通过对662例患者长达13年的经验所获得的支持性数据。
