Baldwin B J, Schusterman M A, Miller M J, Kroll S S, Wang B G
Department of Reconstructive and Plastic Surgery, University of Texas M.D. Anderson Cancer Center.
Plast Reconstr Surg. 1994 Jun;93(7):1410-6; discussion 1417.
Free TRAM flap transfer is now routinely offered to patients requiring breast reconstruction. This study compares results of conventional superior-pedicled TRAM flaps and free TRAM flaps in bilateral breast reconstructions. A total of 92 breasts were reconstructed in 46 patients. Eighteen patients had free TRAM flap reconstructions, and 28 patients were reconstructed with conventional TRAM flaps. Comparison of average operative blood loss and average operative time for the two techniques showed blood loss of 575 cc and an operative time of 9.6 hours for the free TRAM reconstructions and a blood loss of 313 cc and an operative time of 6.6 hours for the conventional TRAM reconstructions. For free TRAM flap reconstructions, both blood loss and operative time decreased significantly between the first and second group of nine patients: from 819 to 360 cc of blood loss and from 10.5 to 8.9 hours of operative time. Partial flap loss (skin and fat necrosis) and fat necrosis only occurred in 13 and 7 percent, respectively, of conventional TRAM flaps, but neither occurred in free TRAM flaps. However, early in the series, three free flaps were lost in two patients, requiring implant placement. Bilateral breast reconstruction using the free TRAM flap may offer a lower complication rate than the conventional TRAM flap by virtue of improved blood supply and less abdominal wall disruption. Surgeons, however, are forewarned that this procedure has a steep learning curve, and surgeons lacking microsurgical expertise may be better served by the conventional TRAM flap.
对于需要进行乳房重建的患者，目前常规采用游离横腹直肌肌皮瓣转移术。本研究比较了传统上蒂横腹直肌肌皮瓣和游离横腹直肌肌皮瓣在双侧乳房重建中的效果。46例患者共重建了92个乳房。18例患者采用游离横腹直肌肌皮瓣重建，28例患者采用传统横腹直肌肌皮瓣重建。两种技术的平均术中失血量和平均手术时间比较显示，游离横腹直肌肌皮瓣重建的失血量为575毫升，手术时间为9.6小时；传统横腹直肌肌皮瓣重建的失血量为313毫升，手术时间为6.6小时。对于游离横腹直肌肌皮瓣重建，在第一组和第二组各9例患者中，失血量和手术时间均显著减少：失血量从819毫升降至36毫升，手术时间从10.5小时降至8.9小时。部分皮瓣丢失（皮肤和脂肪坏死）和单纯脂肪坏死分别仅发生在13%和7%的传统横腹直肌肌皮瓣中，而游离横腹直肌肌皮瓣均未出现。然而，在该系列研究早期，2例患者的3个游离皮瓣坏死，需要植入假体。由于血供改善和腹壁破坏较少，使用游离横腹直肌肌皮瓣进行双侧乳房重建可能比传统横腹直肌肌皮瓣的并发症发生率更低。不过，需要预先提醒外科医生，该手术有一个陡峭的学习曲线，缺乏显微外科专业知识的外科医生可能采用传统横腹直肌肌皮瓣会更好。
