Wilkins E G, August D A, Chang A D, Smith D J
Section of Plastic and Reconstructive Surgery, University of Michigan Medical Center, Ann Arbor.
Am Surg. 1993 Aug;59(8):519-22; discussion 522-4.
Although breast reconstruction has been shown to provide psychological benefits in mastectomy patients, there is reluctance to perform immediate, bilateral TRAM flap reconstruction because of concerns regarding magnitude of the procedure, length of hospitalization, potential complications, and long-term recovery. Between June, 1990 and March 1992, 15 patients underwent immediate, bilateral TRAM flap reconstruction following bilateral mastectomy at the University of Michigan Hospitals. Diagnoses included lobular carcinoma in situ (nine patients), strong family history of breast cancer (five), or bilateral breast cancer (one). Invasive breast cancer was present in three patients. Three modified radical mastectomies and 27 simple mastectomies were performed. Bilateral pedicle TRAM flap reconstruction was carried out at the same time in all patients (30 flaps total). Marginal loss occurred in one flap (3%). Additional complications included marginal necrosis of the abdominal donor site wound (one), wound infection (two), and abdominal donor site hernia (one). Median hospital stay was 7 days. Median follow-up was 13 months (range 4-25 months). All patients have resumed their accustomed pre-operative activity patterns. These findings demonstrate that immediate, bilateral TRAM flap reconstruction is a safe and effective option for breast reconstruction after mastectomy.
尽管乳房重建已被证明能给乳房切除患者带来心理益处，但由于担心手术规模、住院时间、潜在并发症和长期恢复情况，人们不愿进行即刻双侧横行腹直肌肌皮瓣（TRAM瓣）重建术。1990年6月至1992年3月期间，15例患者在密歇根大学医院接受了双侧乳房切除术后的即刻双侧TRAM瓣重建术。诊断包括原位小叶癌（9例）、乳腺癌家族史强烈（5例）或双侧乳腺癌（1例）。3例患者存在浸润性乳腺癌。共进行了3例改良根治性乳房切除术和27例单纯乳房切除术。所有患者均同时进行了双侧带蒂TRAM瓣重建术（共30个瓣）。1个瓣出现边缘坏死（3%）。其他并发症包括腹部供区伤口边缘坏死（1例）、伤口感染（2例）和腹部供区疝（1例）。中位住院时间为7天。中位随访时间为13个月（范围4 - 25个月）。所有患者均已恢复术前的日常活动模式。这些结果表明，即刻双侧TRAM瓣重建术是乳房切除术后乳房重建的一种安全有效的选择。
